Provider Demographics
NPI:1467834838
Name:EDMONDS, ROBERT STEPHEN (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEPHEN
Last Name:EDMONDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380W HORIZON RIDGE PKWY 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5078
Mailing Address - Country:US
Mailing Address - Phone:702-823-4255
Mailing Address - Fax:702-475-3261
Practice Address - Street 1:7540 LANCASHIRE BLVD
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-3784
Practice Address - Country:US
Practice Address - Phone:865-257-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-10-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant