Provider Demographics
NPI:1548902091
Name:EDEN, COURTNEY (APRN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:EDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 GUSTON RD
Mailing Address - Street 2:
Mailing Address - City:GUSTON
Mailing Address - State:KY
Mailing Address - Zip Code:40142-7002
Mailing Address - Country:US
Mailing Address - Phone:270-606-3317
Mailing Address - Fax:
Practice Address - Street 1:25 WOODVIEW LN
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-7940
Practice Address - Country:US
Practice Address - Phone:270-606-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4009698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily