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General NPI Number Information
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NPI Number | 1124903919
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Entity Type | Individual
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Provider Name | BRENDA K EDWARDS OMT
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Gender | Female
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Dates
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Enumeration Date | 08/09/2025
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Last Update Date | 08/31/2025
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Provider Practice Location Address
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Address Line | 400 FOREST HAVEN DR
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-4404
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Country | US
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Telephone | 740-424-3630
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Fax |
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Provider Business Mailing Address
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Address Line | 400 FOREST HAVEN DR
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-4404
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Country | US
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Telephone | 740-424-3630
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Fax |
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | 5099
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 5099
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License Number State | NC
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