=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356821748
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTI EDWARDS FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2018
-----------------------------------------------------
Last Update Date | 05/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1530 VISTA RIDGE DR
-----------------------------------------------------
City | FORNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75126-6258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-585-3351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17350 STATE HIGHWAY 249 STE 220
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77064-1132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-585-3351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 689261
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP138274
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------