MEDICARE: DR. NIKITA EDMONDS DNP, FNP-C

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	22650	TN

General Provider Information

NPI Number	:	1396273496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKITA EDMONDS DNP, FNP-C

Provider Business Mailing Address
First Line	:	1138 N GERMANTOWN PKWY # 101-102
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38016-5872
Country	:	US
Telephone Number	:	901-443-5661
Fax Number	:

Provider Business Practice Location Address
First Line	:	1166 N HOUSTON LEVEE RD STE 104
Second Line	:
City	:	CORDOVA
State	:	TN
Zip	:	38018-7159
Country	:	US
Telephone Number	:	901-443-5661
Fax Number	:

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

Provider Enumeration Date	:	06/01/2017
Last Update Date	:	06/08/2025

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