MEDICARE: DR. JENNIFER GOODE EDWARDS DPM

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	213E00000X	Podiatrist	0103300803	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619990652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER GOODE EDWARDS DPM

Provider Business Mailing Address
First Line	:	PO BOX 74365
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-0007
Country	:	US
Telephone Number	:	804-745-3011
Fax Number	:	877-846-0824

Provider Business Practice Location Address
First Line	:	9409 HULL STREET RD STE B
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1200
Country	:	US
Telephone Number	:	804-745-3011
Fax Number	:	877-846-0824

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	10/27/2025

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