Healthcare Provider Details

I. General information

NPI: 1013494558
Provider Name (Legal Business Name): THERESA KAY EDWARDS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 FAIRINGTON DR
SIDNEY OH
45365-8144
US

IV. Provider business mailing address

1205 FAIRINGTON DR
SIDNEY OH
45365-8144
US

V. Phone/Fax

Practice location:
  • Phone: 937-492-8431
  • Fax: 937-498-5126
Mailing address:
  • Phone: 937-492-8431
  • Fax: 937-498-5126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN301671
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.022941
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: