Organization
EDDYVILLE FAMILY MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISHA R GLENDENING ARNP (OWNER)
(270) 388-0620
Entity
Organization
Contact information
Practice address
209 W MAIN ST, EDDYVILLE, KY 42038-7752
(270) 388-0620
(270) 388-0604
Mailing address
209 W MAIN ST, EDDYVILLE, KY 42038-7752
(270) 388-0620
(270) 388-0604
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1910P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78901758
—
KY
Enumeration date
05/15/2008
Last updated
05/19/2008
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