Provider Demographics
NPI:1285641480
Name:EDWARDS, MARIANNE (APRN)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARIANNE
Other - Middle Name:
Other - Last Name:PRAGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2901 PIGEON ROOST RD
Mailing Address - Street 2:
Mailing Address - City:RUSH
Mailing Address - State:KY
Mailing Address - Zip Code:41168-8132
Mailing Address - Country:US
Mailing Address - Phone:606-928-6648
Mailing Address - Fax:606-928-1056
Practice Address - Street 1:835 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7423
Practice Address - Country:US
Practice Address - Phone:606-547-4400
Practice Address - Fax:606-547-4180
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006122363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100142020Medicaid
P00779196 GRP CB578OtherPALMETTO RR MEDICARE
000000346979OtherANTHEM BCBS
9807604OtherAETNA
000000346979OtherANTHEM BCBS