Healthcare Provider Details

I. General information

NPI: 1689440588
Provider Name (Legal Business Name): ALEXANDRA EDWARDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 S 12TH AVE
LAUREL MS
39440-4325
US

IV. Provider business mailing address

234 S 12TH AVE
LAUREL MS
39440-4325
US

V. Phone/Fax

Practice location:
  • Phone: 601-426-4745
  • Fax: 601-518-7128
Mailing address:
  • Phone: 601-426-4745
  • Fax: 601-518-7128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number913438
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number907779
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: