Provider Demographics
NPI:1164802534
Name:EDWARDS, KATHLEEN T (APN)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:T
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 HIGHWAY 33
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6104
Mailing Address - Country:US
Mailing Address - Phone:732-455-3030
Mailing Address - Fax:
Practice Address - Street 1:2240 HIGHWAY 33
Practice Address - Street 2:SUITE 114
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6104
Practice Address - Country:US
Practice Address - Phone:732-455-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00566700363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology