MEDICARE: MS. TRACY LEE EDWARDS PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP-01949	NM
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71007338A	IN

General Provider Information

NPI Number	:	1568753127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TRACY LEE EDWARDS PMHNP

Provider Business Mailing Address
First Line	:	327 N WORTH AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-8740
Country	:	US
Telephone Number	:	317-850-5992
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 N WORTH AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-8740
Country	:	US
Telephone Number	:	317-850-5992
Fax Number	:

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

Provider Enumeration Date	:	04/29/2011
Last Update Date	:	05/07/2026

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