Healthcare Provider Details

I. General information

NPI: 1154244630
Provider Name (Legal Business Name): NANCY KAY EDWARDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 E PICARD CT
MERIDIAN ID
83646-7249
US

IV. Provider business mailing address

2613 E PICARD CT
MERIDIAN ID
83646-7249
US

V. Phone/Fax

Practice location:
  • Phone: 208-871-2851
  • Fax:
Mailing address:
  • Phone: 208-871-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: