Healthcare Provider Details

I. General information

NPI: 1578375564
Provider Name (Legal Business Name): ELLEN EDWARDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 MOORES LN
LAWRENCEBURG TN
38464-2702
US

IV. Provider business mailing address

616 MARRIOTT DR
NASHVILLE TN
37214-5048
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-6545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: