Eden'S Vantage LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

EDEN'S VANTAGE LLC

Practice address

2553 Pettus Dr
Forney, TX 75126-4172

Phone

(469) 569-5148

NPI assigned

Aug 23, 2021

Organization subpart

No

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

Authorized official

Name

Emmanuel E. Okon, CNP

Title

Ceo

Phone

(469) 569-5148

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662595200000",
    "number": "1104593789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2553 PETTUS DR",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751264172",
            "telephone_number": "469-569-5148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2553 PETTUS DR",
            "city": "FORNEY",
            "state": "TX",
            "postal_code": "751264172",
            "telephone_number": "469-569-5148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN'S VANTAGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-23",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A",
        "authorized_official_last_name": "OKON",
        "authorized_official_first_name": "EMMANUEL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "469-569-5148",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Dyer
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• Makayla Earley
• Kaytlyn Ray Easley
• Lauren Michelle Eddington, CPNP-PC
• Christi Edwards, FNP-C
• L. Reed Elam, MA, LPC
• Abdelrahman Eid Elkady, D.D.S.
• Christi Wright Elkins, LPC
• Taylor Paige Ellis

• Psychiatric/Mental Health Nurse Practitioner in Forney, TX
• Providers in Forney, TX by specialty
• Psychiatric/Mental Health Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.