Individual
DEBRA J EADENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
402 BOGLE ST, STE 3, SOMERSET, KY 42503-2870
(606) 451-9953
(606) 451-1533
Mailing address
402 BOGLE ST, STE 3, SOMERSET, KY 42503-2870
(606) 451-9953
(606) 451-1533
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29813
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000074702
ANTHEM
KY
01
—
04-00404
UNITED HEALTHCARE
KY
01
—
110198804
MEDICARE RAILROAD
KY
01
—
1183452
CHA
KY
01
—
37J8
ANTHEM
KY
01
—
5520074
CCN/AETNA
KY
01
—
611350780
FEDERAL TAX ID
KY
05
—
64298136
—
KY
Enumeration date
11/03/2005
Last updated
06/12/2014
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