MEDICARE: MRS. VERNICIA A EDMOND CRNP

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	261QH0100X	Health Service Clinic/Center
2	261QX0100X	Occupational Medicine Clinic/Center
3	363LF0000X	Family Nurse Practitioner	RN1014617	DC
4	363LF0000X	Family Nurse Practitioner	R182544	MD

General Provider Information

NPI Number	:	1568909570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERNICIA A EDMOND CRNP

Provider Business Mailing Address
First Line	:	2490 MARKET ST NE STE G
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-3851
Country	:	US
Telephone Number	:	240-310-9289
Fax Number	:

Provider Business Practice Location Address
First Line	:	5600 RIVERTECH CT STE G
Second Line	:
City	:	RIVERDALE
State	:	MD
Zip	:	20737-1354
Country	:	US
Telephone Number	:	301-310-9289
Fax Number	:

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

Provider Enumeration Date	:	01/28/2017
Last Update Date	:	04/03/2025

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