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Individual
MR. EDDIE A MANLEY
Active
Individual
MR. EDDIE A MANLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
15072
TN
363L00000X
Nurse Practitioner
Primary
3006470
KY
363L00000X
Nurse Practitioner
5005075
NC
363LF0000X
Family Nurse Practitioner
3006470
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15072
TENNESSE LICENSE NUMBER APRN
TN
01
—
3006470
KY APRN LICENSE NUMBER
KY
01
—
5005075
NC APRN LICENSE NUMBER
NC
05
—
7100138050
—
KY
Enumeration date
03/02/2010
Last updated
04/29/2018
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