Healthcare Provider Details

I. General information

NPI: 1548178932
Provider Name (Legal Business Name): MISTY DAWN EDWARDS ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 E JACKSON ST
GATE CITY VA
24251-3526
US

IV. Provider business mailing address

340 E JACKSON ST
GATE CITY VA
24251-3526
US

V. Phone/Fax

Practice location:
  • Phone: 276-386-6118
  • Fax: 276-386-2684
Mailing address:
  • Phone: 276-386-6118
  • Fax: 276-386-2684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPGP-0714684
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: