Healthcare Provider Details

I. General information

NPI: 1467895839
Provider Name (Legal Business Name): ALICE R EDWARDS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1965 S FREMONT AVE
SPRINGFIELD MO
65804-2201
US

IV. Provider business mailing address

9135 SW BARNES RD STE 461
PORTLAND OR
97225-6643
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-9055
  • Fax:
Mailing address:
  • Phone:
  • Fax: 631-444-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2026031156
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: