Healthcare Provider Details

I. General information

NPI: 1316272891
Provider Name (Legal Business Name): COURTNEY LYNN EDMONDSON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11279 PERRY HWY SUITE 108
WEXFORD PA
15090-9381
US

IV. Provider business mailing address

11279 PERRY HWY SUITE 450
WEXFORD PA
15090-9381
US

V. Phone/Fax

Practice location:
  • Phone: 724-933-9190
  • Fax: 724-933-9194
Mailing address:
  • Phone: 724-933-1100
  • Fax: 724-933-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054078
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberMA054078
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: