MEDICARE: JEFFREY TRENT EDWARDS MSN, FNP-BC

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	163W00000X	Registered Nurse	967363	TX
2	164X00000X	Licensed Vocational Nurse	315375	TX
3	363LF0000X	Family Nurse Practitioner	1111769	TX

General Provider Information

NPI Number	:	1558060715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY TRENT EDWARDS MSN, FNP-BC

Provider Business Mailing Address
First Line	:	11511 SHADOW CREEK PKWY
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-7298
Country	:	US
Telephone Number	:	713-442-0000
Fax Number	:	713-442-4735

Provider Business Practice Location Address
First Line	:	1200 MCKINNEY ST STE 473
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77010-2004
Country	:	US
Telephone Number	:	713-442-4700
Fax Number	:	713-442-4735

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

Provider Enumeration Date	:	02/27/2023
Last Update Date	:	04/11/2023

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