Healthcare Provider Details

I. General information

NPI: 1275046054
Provider Name (Legal Business Name): CHELSEA Q EDWARDS RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WESTSIDE SQ # 750
HUNTSVILLE AL
35801-4823
US

IV. Provider business mailing address

200 WESTSIDE SQ # 750
HUNTSVILLE AL
35801-4823
US

V. Phone/Fax

Practice location:
  • Phone: 256-783-9530
  • Fax:
Mailing address:
  • Phone: 256-783-9530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2822
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number2822
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2822
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: