Healthcare Provider Details

I. General information

NPI: 1447928890
Provider Name (Legal Business Name): KOURTNEY LOUISE EDWARDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 GENESEE AVE
LA JOLLA CA
92037-1224
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-7700
  • Fax:
Mailing address:
  • Phone: 858-554-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number95017759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: