Healthcare Provider Details

I. General information

NPI: 1467834838
Provider Name (Legal Business Name): ROBERT STEPHEN EDMONDS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 LANCASHIRE BLVD
POWELL TN
37849-3784
US

IV. Provider business mailing address

2380 W HORIZON RIDGE PKWY STE 110
HENDERSON NV
89052-5078
US

V. Phone/Fax

Practice location:
  • Phone: 865-257-3380
  • Fax:
Mailing address:
  • Phone: 702-823-4255
  • Fax: 702-475-3261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13571
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: