Healthcare Provider Details

I. General information

NPI: 1740915610
Provider Name (Legal Business Name): KRISTEN EDNEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2022
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 MEDICAL DR
TYLER TX
75701-2130
US

IV. Provider business mailing address

1133 MEDICAL DR
TYLER TX
75701-2130
US

V. Phone/Fax

Practice location:
  • Phone: 903-595-5486
  • Fax: 903-595-5128
Mailing address:
  • Phone: 903-595-5486
  • Fax: 903-595-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number702888
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1097191
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1097191
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: