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General NPI Number Information
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NPI Number | 1801541743
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Entity Type | Individual
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Provider Name | PAUL ALAN EDWARDS
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Gender | Male
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Dates
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Enumeration Date | 02/18/2022
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 1765 BELLEVUE RD
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City | HAUGHTON
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State | LA
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Zip | 71037-7541
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Country | US
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Telephone | 318-453-4716
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Fax |
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Provider Business Mailing Address
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Address Line | 1765 BELLEVUE RD
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City | HAUGHTON
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State | LA
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Zip | 71037-7541
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Country | US
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Telephone | 318-453-4716
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | J00119
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License Number State | LA
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