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General NPI Number Information
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NPI Number | 1689455230
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Entity Type | Individual
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Provider Name | EDNA KABISA PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/10/2023
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 4420 LAKE BOONE TRL
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City | RALEIGH
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State | NC
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Zip | 27607-7505
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Country | US
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Telephone | 919-784-3542
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Fax |
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Provider Business Mailing Address
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Address Line | 5221 PARAMOUNT PKWY, STE 420
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City | MORRISVILLE
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State | NC
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Zip | 27560-5491
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Country | US
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Telephone | 984-974-1256
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Fax | 984-974-1316
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-13397
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-13397
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License Number State | NC
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