Healthcare Provider Details

I. General information

NPI: 1285514679
Provider Name (Legal Business Name): MAKAILA EDWARDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10683 EDWARDS LN
OMAHA AR
72662-9169
US

IV. Provider business mailing address

10683 EDWARDS LN
OMAHA AR
72662-9169
US

V. Phone/Fax

Practice location:
  • Phone: 870-715-5698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number124632
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: