| Organization Name: | EDDYVILLE FAMILY MEDICAL |
| NPI Number: | 1639346844 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MISHA R GLENDENING (OWNER) |
| Mailing Address: | 209 W Main St Eddyville |
| State: | KY US |
| Postal Code: | 420387752 |
| Phone Number: | 2703880620 |
| Fax Number: | 2703880604 |
| NPI Enumeration Date: | 05/15/2008 |
| NPI Last Update Date: | 05/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 1910P |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |