Healthcare Provider Details

I. General information

NPI: 1306325907
Provider Name (Legal Business Name): LINDA EDWARDS MS, TCADC, TCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2375 PROFESSIONAL HEIGHTS DR STE 240
LEXINGTON KY
40503-3040
US

IV. Provider business mailing address

1530 LITTLE HICKMAN RD
NICHOLASVILLE KY
40356-9551
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone: 859-327-7351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: