Healthcare Provider Details

I. General information

NPI: 1548725310
Provider Name (Legal Business Name): NAKIA ANTOINETTE EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NAKIA ANTOINETTE POWELL

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FLORIDA AVE STE 100
MODESTO CA
95350-4438
US

IV. Provider business mailing address

3055 FLOYD AVE APT 245
MODESTO CA
95355-7932
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-3388
  • Fax: 209-338-0024
Mailing address:
  • Phone: 334-421-7476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1-141525
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberNP95011384
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0137900
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: