Healthcare Provider Details

I. General information

NPI: 1891361762
Provider Name (Legal Business Name): KRISTYN EDWARDS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 GLADES RD STE 8
BEREA KY
40403-1368
US

IV. Provider business mailing address

PO BOX 802
BEREA KY
40403-0802
US

V. Phone/Fax

Practice location:
  • Phone: 859-428-7862
  • Fax: 859-999-7869
Mailing address:
  • Phone: 859-428-7862
  • Fax: 859-999-7869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: