=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528439668
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAELI MICHELLE EDMONDS CRNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2015
-----------------------------------------------------
Last Update Date | 11/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2780 BOB WALLACE AVE SW
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35805-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-533-4626
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2780 BOB WALLACE AVE SW
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35805-4104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-533-4626
-----------------------------------------------------
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 | 1-140046
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------