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General NPI Number Information
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NPI Number | 1588132674
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Entity Type | Individual
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Provider Name | MARIAH EDWARDS PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 1100 ALLIED DR
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City | PLANO
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State | TX
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Zip | 75093-5348
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Country | US
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Telephone | 713-790-2089
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 NAVASOTA TRL
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City | PLANO
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State | TX
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Zip | 75075-1216
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Country | US
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Telephone | 580-284-6530
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | TX
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