Provider Demographics
NPI:1003462789
Name:EDWARDS, KEDESHA
Entity Type:Individual
Prefix:
First Name:KEDESHA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7081 NW 16TH ST APT B110
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5232
Mailing Address - Country:US
Mailing Address - Phone:954-404-2619
Mailing Address - Fax:
Practice Address - Street 1:7081 NW 16TH ST APT B110
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-5232
Practice Address - Country:US
Practice Address - Phone:954-404-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care