MEDICARE: DR. JASMINE GAIL EDWARDS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3793	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447354121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASMINE GAIL EDWARDS PH.D.

Provider Business Mailing Address
First Line	:	100 GREENDALE DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-1576
Country	:	US
Telephone Number	:	937-298-1763
Fax Number	:

Provider Business Practice Location Address
First Line	:	1339 WOODMAN DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45432-3425
Country	:	US
Telephone Number	:	937-253-1987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	10/12/2008

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