MEDICARE: KRISHULA EDWARDS

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1649805805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISHULA EDWARDS

Provider Business Mailing Address
First Line	:	6028 TAMARACK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1300
Country	:	US
Telephone Number	:	334-300-2028
Fax Number	:

Provider Business Practice Location Address
First Line	:	6028 TAMARACK DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-1300
Country	:	US
Telephone Number	:	334-245-4243
Fax Number	:

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

Provider Enumeration Date	:	03/09/2020
Last Update Date	:	12/27/2022

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