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General NPI Number Information
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NPI Number | 1508525965
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Entity Type | Individual
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Provider Name | STEPHANIE YOLANDA EDWARDS
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Gender | Female
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Dates
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Enumeration Date | 12/14/2021
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Last Update Date | 12/14/2021
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Provider Practice Location Address
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Address Line | 283 RACE ST, ROLLING FORK, MS 39159
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City | ROLLING FORK
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State | MS
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Zip | 39159
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Country | US
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Telephone | 662-873-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 302 STARLITE DR
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City | YAZOO CITY
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State | MS
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Zip | 39194
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Country | US
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Telephone | 662-571-3171
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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 | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number | 905048
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License Number State | MS
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