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1104063262 NPI number — CARLENE KAY EDWARDS FNP

NPI Number: 1104063262
Health Care Provider/Practitioner: CARLENE KAY EDWARDS FNP

Information about “1104063262” NPI (CARLENE KAY EDWARDS FNP) exists in 1104063262 in HTML format HTML  |  1104063262 in plain Text format TXT  |  1104063262 in PDF (Portable Document Format) PDF  |  1104063262 in an XML format XML  formats.

NPI Number : 1104063262 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104063262",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EDWARDS",
    "FirstName": "CARLENE",
    "MiddleName": "KAY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EDWARDS-ROBB",
    "OtherFirstName": "CARLENE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "FNP",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "6201 GREENLEIGH AVE FL 2",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIDDLE RIVER",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21220-2004",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-933-2704",
    "MailingAddressFaxNumber": "410-500-4266",
    "FirstLinePracticeLocationAddress": "1800 ORLEANS ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21287-0010",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-955-8751",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/12/2009",
    "LastUpdateDate": "01/16/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "F335592-1",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "R220333",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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