Healthcare Provider Details

I. General information

NPI: 1669158564
Provider Name (Legal Business Name): TERRA NICOLE EDWARDS APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 14TH ST NE
EAST GRAND FORKS MN
56721-1626
US

IV. Provider business mailing address

203 14TH ST NE
EAST GRAND FORKS MN
56721-1626
US

V. Phone/Fax

Practice location:
  • Phone: 218-693-2014
  • Fax:
Mailing address:
  • Phone: 218-693-2014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR40306
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: