Healthcare Provider Details

I. General information

NPI: 1215376710
Provider Name (Legal Business Name): MIRANDA NICOLE EDWARDS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIRANDA BARNES

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3203 N 6TH ST
FORT SMITH AR
72904-4165
US

IV. Provider business mailing address

3203 N 6TH ST
FORT SMITH AR
72904-4165
US

V. Phone/Fax

Practice location:
  • Phone: 479-783-3900
  • Fax:
Mailing address:
  • Phone: 479-783-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.063393
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0059094
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-20611
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.063393
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: