MEDICARE: MRS. LATRICIA NIKIA EDWARDS C.R.N.P

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	363LP0200X	Pediatric Nurse Practitioner	1-101843	AL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.11559	OH
3	363LP0200X	Pediatric Nurse Practitioner	COA.11559-NP	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	:	1861799983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LATRICIA NIKIA EDWARDS C.R.N.P

Provider Business Mailing Address
First Line	:	4040 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1156
Country	:	US
Telephone Number	:	614-350-1970
Fax Number	:	866-379-0276

Provider Business Practice Location Address
First Line	:	20620 JOHN CARROLL BLVD STE 214
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-4540
Country	:	US
Telephone Number	:	440-622-7444
Fax Number	:

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

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	03/06/2026

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