Provider Demographics
NPI:1245206283
Name:EDWARDS, KIMINI AMBER HELTON (CRNA)
Entity Type:Individual
Prefix:
First Name:KIMINI
Middle Name:AMBER HELTON
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIMINI
Other - Middle Name:A
Other - Last Name:HELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7506 WOLFTEVER TRL
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6216
Mailing Address - Country:US
Mailing Address - Phone:423-309-9927
Mailing Address - Fax:
Practice Address - Street 1:7506 WOLFTEVER TRL
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6216
Practice Address - Country:US
Practice Address - Phone:423-309-9927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11389367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4047501OtherBCBS
TN3631944OtherMEDICARE
TN3631944Medicaid
TN3631944Medicaid