MEDICARE: MRS. THERESA KAY EDWARDS APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	RN301671	OH
2	363LG0600X	Gerontology Nurse Practitioner	APRN.CNP.022941	OH

General Provider Information

NPI Number	:	1013494558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THERESA KAY EDWARDS APRN-CNP

Provider Business Mailing Address
First Line	:	1205 FAIRINGTON DR
Second Line	:
City	:	SIDNEY
State	:	OH
Zip	:	45365-8144
Country	:	US
Telephone Number	:	937-492-8431
Fax Number	:	937-498-5126

Provider Business Practice Location Address
First Line	:	1205 FAIRINGTON DR
Second Line	:
City	:	SIDNEY
State	:	OH
Zip	:	45365-8144
Country	:	US
Telephone Number	:	937-492-8431
Fax Number	:	937-498-5126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	12/01/2020

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