Provider Demographics
NPI:1275909525
Name:EDWARDS, KONEECHIA CHARMAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:KONEECHIA
Middle Name:CHARMAINE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KONEECHIA
Other - Middle Name:CHARMAINE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C, AGACNP-BC
Mailing Address - Street 1:10780 FURLONG DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-9643
Mailing Address - Country:US
Mailing Address - Phone:559-904-9588
Mailing Address - Fax:
Practice Address - Street 1:1105 N DOUTY ST STE B
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3787
Practice Address - Country:US
Practice Address - Phone:559-582-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA789677163W00000X
CA95002883363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse