MEDICARE: JACQUELYN EDWARDS

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	225700000X	Massage Therapist		AK

General Provider Information

NPI Number	:	1972368611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN EDWARDS

Provider Business Mailing Address
First Line	:	1920 EARLY VIEW DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-2958
Country	:	US
Telephone Number	:	907-360-0738
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 G ST STE 308
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99501-2135
Country	:	US
Telephone Number	:	907-602-8110
Fax Number	:

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

Provider Enumeration Date	:	02/20/2024
Last Update Date	:	05/29/2026

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Directions to “ JACQUELYN EDWARDS ” Practice Location

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