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General NPI Number Information
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NPI Number | 1013494558
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Entity Type | Individual
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Provider Name | THERESA KAY EDWARDS APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 1205 FAIRINGTON DR
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City | SIDNEY
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State | OH
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Zip | 45365-8144
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Country | US
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Telephone | 937-492-8431
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Fax | 937-498-5126
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Provider Business Mailing Address
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Address Line | 1205 FAIRINGTON DR
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City | SIDNEY
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State | OH
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Zip | 45365-8144
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Country | US
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Telephone | 937-492-8431
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Fax | 937-498-5126
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN301671
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN.CNP.022941
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License Number State | OH
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