Provider Demographics
NPI:1477859015
Name:EDWARDS, CRAIG JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:JAMES
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 BIG HORN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-9208
Mailing Address - Country:US
Mailing Address - Phone:307-578-1955
Mailing Address - Fax:307-578-1996
Practice Address - Street 1:3030 BIG HORN AVE STE C
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-9208
Practice Address - Country:US
Practice Address - Phone:307-578-1955
Practice Address - Fax:307-578-1996
Is Sole Proprietor?:No
Enumeration Date:2011-01-30
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MTPA589363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant