Healthcare Provider Details

I. General information

NPI: 1366443434
Provider Name (Legal Business Name): EDWARD JOHN KUHNLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 05/05/2024
Certification Date: 05/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-2283
US

IV. Provider business mailing address

103 RUM RUNNER WAY
ST JOHNS FL
32259-2267
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-5211
  • Fax:
Mailing address:
  • Phone: 434-316-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21761
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101029164
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: