MEDICARE: MRS. MEGAN PETTREY EDMONDS RPRS

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	106S00000X	Behavior Technician
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1043147408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN PETTREY EDMONDS RPRS

Provider Business Mailing Address
First Line	:	3830 MONZA DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-4214
Country	:	US
Telephone Number	:	804-275-3565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 MONZA DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-4214
Country	:	US
Telephone Number	:	804-275-3565
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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