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NPI Code Detail

MEDICARE: DYLAN EDWARDS

MEDICARE:   DYLAN  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
12255A2300XAthletic TrainerNC

General Provider Information

NPI Number : 1750226692
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN EDWARDS
Provider Business Mailing Address
First Line : 138 GOOSES WAY
Second Line :
City : LAKE LURE
State : NC
Zip : 28746-8833
Country : US
Telephone Number : 423-664-7715
Fax Number :
Provider Business Practice Location Address
First Line : 287 RIVERS STREET
Second Line :
City : BOONE
State : NC
Zip : 28608-2009
Country : US
Telephone Number : 423-664-7715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2026
Last Update Date : 04/20/2026

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Directions to “ DYLAN EDWARDS ” Practice Location

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