Healthcare Provider Details

I. General information

NPI: 1811100886
Provider Name (Legal Business Name): KATHRYN EDWARDS LSPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 SANDERS FERRY RD SUITE 203
HENDERSONVILLE TN
37075-3662
US

IV. Provider business mailing address

131 SANDERS FERRY RD SUITE 203
HENDERSONVILLE TN
37075-3662
US

V. Phone/Fax

Practice location:
  • Phone: 615-822-0211
  • Fax: 615-822-8306
Mailing address:
  • Phone: 615-822-0211
  • Fax: 615-822-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPE847
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: