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General NPI Number Information
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NPI Number | 1174388409
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Entity Type | Individual
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Provider Name | VERNON J EDMONDSON APRN-CNP
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Gender | Male
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 2501 W WILLIAM CANNON DR BLDG 4
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City | AUSTIN
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State | TX
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Zip | 78745-5281
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Country | US
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Telephone | 512-472-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 501 E OLTORF ST APT 218
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City | AUSTIN
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State | TX
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Zip | 78704-5625
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Country | US
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Telephone | 617-935-4004
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1044681
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License Number State | TX
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