=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285380261
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALYSA F EDWARDS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2022
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9040 JACKSON AVE
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98431-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-968-1250
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1650 COCHRANE CIR
-----------------------------------------------------
City | FORT CARSON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80913-4613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-526-7111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | DR.0071539
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 0071539
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------