MEDICARE: STEPHANIE EDMONDSON APRN

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	363LF0000X	Family Nurse Practitioner	223478	AR
2	363LF0000X	Family Nurse Practitioner	907565	MS

General Provider Information

NPI Number	:	1073212585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE EDMONDSON APRN

Provider Business Mailing Address
First Line	:	2101 HIGHWAY 90
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5340
Country	:	US
Telephone Number	:	228-497-7576
Fax Number	:	228-497-8869

Provider Business Practice Location Address
First Line	:	3535 BIENVILLE BLVD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5705
Country	:	US
Telephone Number	:	228-872-1641
Fax Number	:	228-809-5585

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

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	09/25/2025

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Directions to “ STEPHANIE EDMONDSON APRN” Practice Location

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