Healthcare Provider Details

I. General information

NPI: 1396679593
Provider Name (Legal Business Name): REBECCA EDELMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 N MITCHELL RD
MANSFIELD TX
76063-3449
US

IV. Provider business mailing address

180 HUNTERS GLEN DR
WAXAHACHIE TX
75167-7204
US

V. Phone/Fax

Practice location:
  • Phone: 682-422-9950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1250339
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: