ANDREA BETH EDGERLY (NPI# 1922506948) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922506948 |
| Entity Type | Individual |
| Full Name | ANDREA BETH EDGERLY |
| Credential | FNP |
| Practice Address |
621 Memorial Dr Ste 402 South Bend IN 46601-1074 |
| Mailing Address |
2401 Valley Dr Valparaiso IN 46383-2520 |
| Practice Telephone | 5744004550 |
| Practice Fax Number | 5744004551 |
| Mailing Telephone | 2194135100 |
| Mailing Fax Number | 2194659502 |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2019-01-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
71007815A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
28240769A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | MEDICARE PTAN | 178420026 | 01 |
| IN | 300011718 | 05 |
| Street Address |
621 MEMORIAL DR STE 402 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46601-1074 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710962915 | Brandon William Zabukovic | Family Medicine | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2005-12-09 |
| 1528679891 | Rebecca Louise Kray | Nurse Practitioner | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2020-08-11 |
| 1932678679 | Ashley Brunt | Social Worker | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2018-11-23 |
| 1972071769 | Healthlinc, Inc | Clinic/Center | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2018-11-09 |
| 1538641105 | Christine Lynn Romack | Nurse Practitioner | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2018-08-30 |
| 1245722586 | Carolyn Horin | Nurse Practitioner | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2018-06-02 |
| 1861879264 | Joyce Ellen Racz | Nurse Practitioner | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2015-05-05 |
| 1881018729 | Rebekah Kottkamp | Nurse Practitioner | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2014-02-12 |
| 1558623686 | Michael Sean Kozak | Family Medicine | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2012-06-14 |
| 1144479460 | Christine Elizabeth Coulter | Nurse Practitioner | 621 Memorial Dr Ste 402, South Bend, IN 46601-1074 | 2008-09-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447610449 | David Thomas | Hearing Instrument Specialist | 808 S Michigan St., South Bend, IN 46601 | 2016-03-03 |
| 1285072454 | Kevin Francis Cumper | Internal Medicine | 621 Memorial Dr Ste 624, South Bend, IN 46601 | 2013-06-11 |
| 1952605560 | Robert Lusk Bonham | Dentist | 1222 L.w.e., So. Bend, IN 46601 | 2010-12-23 |
| 1649580911 | Daniel Scott Debrule | Psychologist | 211 W. Washington Street, Suite 2311, South Bend, IN 46601 | 2010-10-20 |
| 1528390770 | Luke Alfred White | Internal Medicine | 615 N. Michigan St., Memorial Hospital, C/o Erin Smith, South Bend, IN 46601 | 2010-02-12 |
| 1548497837 | Tmg Home Health Care | Home Health | 108 N Main St #305, South Bend, IN 46601 | 2009-06-15 |
| 1225283039 | Jody L. Hughes | Counselor | 202 S. Michigan Street, Suite 875, South Bend, IN 46601 | 2008-11-20 |
| 1740432574 | Amanda Jayne Quicksall | Social Worker | 611 Lincolnway W, South Bend, IN 46601 | 2008-10-10 |
| 1952565772 | Thomas P Judd | Dentist | 1901 #b Western Avenue, Ihc South Bend, South Bend, IN 46601 | 2008-07-10 |
| 1851590269 | Warren Larry Penrod | Nurse Practitioner | 333 W. Western Ave, South Bend, IN 46601 | 2007-07-16 |
| Find all providers in zip 46601 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205334927 | Martha Wahu Mburu | Nurse Practitioner | 17747 Tallyho Dr E, South Bend, IN 46635-1040 | 2018-01-28 |
| 1194245324 | Sameka Renee Dowell Mills | Nurse Practitioner | 112 W Jefferson Blvd Ste 600, South Bend, IN 46601-1921 | 2017-06-20 |
| 1265826226 | Mario Remedios Ortiz | Nurse Practitioner | 1700 Mishawaka Ave # Sac-130, Health & Wellness Center, Iu South Bend, South Bend, IN 46615-1408 | 2015-03-26 |
| 1023400454 | Amanda Lundberg | Nurse Practitioner | 53830 Generations Dr Ste 110, South Bend, IN 46635-1538 | 2015-02-23 |
| 1932520426 | Stephanie Brenneman | Nurse Practitioner | 943 S 25th St, South Bend, IN 46615-1707 | 2013-12-30 |
| 1467747014 | Deidre A Coffey | Nurse Practitioner | 1025 Widener Ln, South Bend, IN 46614 | 2011-06-12 |
| 1083919161 | Caitlin Vlaeminck | Nurse Practitioner | 6301 University Commons Ste 320, South Bend, IN 46635-1479 | 2011-01-20 |
| 1851590269 | Warren Larry Penrod | Nurse Practitioner | 333 W. Western Ave, South Bend, IN 46601 | 2007-07-16 |
| 1780620005 | Barbara Ann Norris | Nurse Practitioner | 1432 Lincoln Way E, South Bend, IN 46613-3205 | 2006-06-22 |
| 1184629891 | Sharon K Klingerman | Nurse Practitioner | 100 Navarre Pl, Ste 5550, South Bend, IN 46601-1169 | 2005-06-17 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46601 |
Please comment or provide details below to improve the information on ANDREA BETH EDGERLY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.