Individual
EDNA BETH NETTLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2706 HESSMER AVE, SUITE A, METAIRIE, LA 70002-7041
(504) 754-2334
(504) 324-2078
Mailing address
2706 HESSMER AVE, SUITE A, METAIRIE, LA 70002-7041
(504) 754-2334
(504) 324-2078
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1680
TN
363A00000X
Physician Assistant
PA200705
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1505839
—
TN
05
—
1509761
—
TN
01
—
4211276
BCBS TN
TN
Enumeration date
10/28/2008
Last updated
07/27/2015
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