Ketti Lynn Eddy, APRN-CNP
Individual provider Active NPI Family Nurse Practitioner · Guthrie, OK
NPI 1194723239 · NPPES record last updated Sep 25, 2021
Key facts
- NPI
- 1194723239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R0074528 (OK)
- Practice address
- 105 E Industrial Rd Ste B
Guthrie, OK 73044-6971 - Phone
- (405) 919-7570
- Fax
- (405) 256-9748
- NPI assigned
- Jul 12, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050824000639 | OK | Practitioner - Nurse Practitioner | 8426094475 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0074528 | OK | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fusion MD PLLC | Current |
Accepting new patients | |
| Marshall County Hma LLC | Past | Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients |
Locations
5472 Main St
Ste 101
Oklahoma City, OK 73115
Phone (405) 607-5920
Interoperability endpoints
- ketti.eddy@359482257768452.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R0074528 | OK | Yes |
Addresses
Primary practice location
105 E Industrial Rd Ste B
Guthrie, OK 73044-6971
Mailing address
1603 Hunters Path
Edmond, OK 73034-1627
Phone (405) 919-7570
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200057880A | Medicaid | OK |
Other providers in Guthrie, OK
- Eagle Ridge
- Eagle Ridge Family Treatment Center
- Eagle Ridge Family Treatment Center
- Eagle Ridge Institute
- Deborah Renee Easton
- Zachary T Edens
- Denise Ergang
- Everbloom Therapy & Co.
- Holly V Evers
- Lauren Faye Faris
All providers in Guthrie, OK · Family Nurse Practitioner in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.