MEDICARE: MRS. CHILLENA EDWARDS FNP

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	363L00000X	Nurse Practitioner	204127	LA
2	363LF0000X	Family Nurse Practitioner	204127	LA

General Provider Information

NPI Number	:	1073072310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHILLENA EDWARDS FNP

Provider Business Mailing Address
First Line	:	8787 SHEPHARD DR
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-6338
Country	:	US
Telephone Number	:	504-621-6019
Fax Number	:

Provider Business Practice Location Address
First Line	:	8787 SHEPHARD DR
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-6338
Country	:	US
Telephone Number	:	504-621-6019
Fax Number	:

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

Provider Enumeration Date	:	03/16/2019
Last Update Date	:	03/31/2026

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