MEDICARE: DARA BREON EDWARDS NP

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	363LF0000X	Family Nurse Practitioner	135137	TX

General Provider Information

NPI Number	:	1912484932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARA BREON EDWARDS NP

Provider Business Mailing Address
First Line	:	3702 AMOROSO DR
Second Line	:
City	:	IOWA COLONY
State	:	TX
Zip	:	77583-1190
Country	:	US
Telephone Number	:	832-865-2821
Fax Number	:

Provider Business Practice Location Address
First Line	:	8498 S SAM HOUSTON PKWY E STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-4892
Country	:	US
Telephone Number	:	832-937-5919
Fax Number	:

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

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	11/15/2022

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