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NPI Code Detail

MEDICARE: DESTANY EDWARDS

MEDICARE: DESTANY EDWARDS
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
1235Z00000XSpeech-Language Pathologist251043KY

General Provider Information

NPI Number : 1457841249
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTANY EDWARDS
Provider Business Mailing Address
First Line : 432 BOULDER DR
Second Line :
City : LONDON
State : KY
Zip : 40741-8809
Country : US
Telephone Number : 606-260-7646
Fax Number :
Provider Business Practice Location Address
First Line : 8706 S US HIGHWAY 25
Second Line :
City : CORBIN
State : KY
Zip : 40701-4974
Country : US
Telephone Number : 606-677-1166
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2018
Last Update Date : 07/11/2019

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Directions to “ DESTANY EDWARDS ” Practice Location

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