Healthcare Provider Details

I. General information

NPI: 1154635407
Provider Name (Legal Business Name): EDWARDS CLINIC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 TOWN BRANCH ROAD
MANCHESTER KY
40962-1322
US

IV. Provider business mailing address

204 TOWN BRANCH RD
MANCHESTER KY
40962-1322
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-8766
  • Fax: 606-598-1903
Mailing address:
  • Phone: 606-598-8766
  • Fax: 606-598-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANA EDWARDS
Title or Position: PRESIDENT
Credential: MD
Phone: 606-598-8766