MEDICARE: EDWARD JOHN KUHNLEY M.D.

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	2084P0800X	Psychiatry Physician	21761	CT
2	2084P0804X	Child & Adolescent Psychiatry Physician	0101029164	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	186465	OTHER	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	203639329001	OTHER	TRICARE PROVIDER NUMBER
4	204775	OTHER	VALUE OPTIONS PROVIDER NU
5	2120869	OTHER	CIGNA BEHAVIOR PROVIDER N
6	O85925	OTHER	SENTARA PROVIDER NUMBER
7	20-3639329	OTHER	PCHP PROVIDER NUMBER

General Provider Information

NPI Number	:	1366443434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD JOHN KUHNLEY M.D.

Provider Business Mailing Address
First Line	:	103 RUM RUNNER WAY
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-2267
Country	:	US
Telephone Number	:	434-316-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	3345 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2283
Country	:	US
Telephone Number	:	928-445-5211
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/05/2024

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Directions to “ EDWARD JOHN KUHNLEY M.D.” Practice Location

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