Healthcare Provider Details

I. General information

NPI: 1881688810
Provider Name (Legal Business Name): AMY S EDWARDS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W TARGEE ST APT 102
BOISE ID
83705-4494
US

IV. Provider business mailing address

20054 CRESTVIEW DR
CANYON COUNTRY CA
91351-5756
US

V. Phone/Fax

Practice location:
  • Phone: 818-731-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax: 208-345-1890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM-11410
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: