Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | ND28769 | TN |
N | 208000000X | Pediatrician | MD28769 | TN |
N | 2080P0204X | Pediatric Emergency Doctor | MD28769 | TN |
NPI | 1205871738 |
---|---|
Provider Name | Dr. Heather Edgley |
First Address | Knoxville, TN 37932-1984 |
Second Address | Knoxville, TN 37916-2301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 07/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3065905 | BLUE CROSS (01) | TN |
3810473 | (05) | TN |
64926264 | (05) | KY |