Individual provider Active NPI

Edna S Bagoyado, FNP

  • Family Nurse Practitioner
  • Memphis, TN
National Provider Identifier
1083076343
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APN20934 Issued in TN
Practice address
3889 Park Ave
Memphis, TN 38111-6634
Phone
(901) 401-7140
NPI assigned
Mar 25, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APN20934 TN Primary

Addresses

Primary practice location

3889 Park Ave
Memphis, TN 38111-6634

Mailing address

PO Box 746725
Atlanta, GA 30374-6725
Phone (312) 733-9730

Other practice location 1

1030 Jefferson Ave
Memphis, TN 38104-2127
Phone (901) 523-8990 ext. 7867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250613000413 TN Practitioner - Nurse Practitioner 9133630544 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osh Mi Physicians Group, PCGroup PAC ID 7810282191, 154 clinicians

Practice addresses (Care Compare)

3889 Park Ave
Memphis, TN 38111-6634
Phone (901) 401-7140

Hospital & facility affiliations

  • Methodist Hospitals of Memphis Hospital, Memphis, TN, CCN 440049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APN20934TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Oak Street Health Physicians Group of Tennessee, PLLC CurrentSince May 18, 2025 Accepting new patients
Osh Mi Physicians Group, PC CurrentSince Jul 7, 2025 Accepting new patients
Osh-Mi Physicians Group PC Family PastSince May 18, 2025 Accepting new patients

Locations

3889 Park Ave
Memphis, TN 38111
Phone (901) 401-7140

3360 N Watkins St
Memphis, TN 38127
Phone (901) 353-4603

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1083076343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746725",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746725",
            "telephone_number": "312-733-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3889 PARK AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381116634",
            "telephone_number": "901-401-7140"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1030 Jefferson Ave",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381042127",
            "country_code": "US",
            "telephone_number": "901-523-8990 x7867",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BAGOYADO",
        "first_name": "EDNA",
        "middle_name": "S",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-25",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN20934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.