Eden Holistic Medicine and Wellness, PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

OS014960 Issued in PA

Legal business name

EDEN HOLISTIC MEDICINE AND WELLNESS, PC

Practice address

412 E King St
Malvern, PA 19355-3004

Phone

(610) 833-8739

Fax

(610) 647-8921

NPI assigned

May 5, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Kimberley E Jackson, D.O.

Title

President

Phone

(610) 833-8739

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1273017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273017600000",
    "number": "1447578117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 E KING ST",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193553004",
            "telephone_number": "610-833-8739",
            "fax_number": "610-647-8921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 E KING ST",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193553004",
            "telephone_number": "610-833-8739",
            "fax_number": "610-647-8921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDEN HOLISTIC MEDICINE AND WELLNESS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-05",
        "last_updated": "2010-05-05",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "KIMBERLEY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-833-8739",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "PA",
            "license": "OS014960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lei Duan
• Jodie Catherine Duncan, PHARMD
• Olivia Dunion
• East Whiteland Township Fire Association
• Brenda L Eaton, BCBA
• Kimberly C Edmonds, M.S., CCC-SLP
• Ali Ibrahim El-Kerdi, PHD, PT, ATC
• Courtney Rosaire Elgindy, CRNP
• Marguerite Kearney Ellenbaum, LCSW
• Ellie Main Line LLC

• General Practice Physician in Malvern, PA
• Providers in Malvern, PA by specialty
• General Practice Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.