Provider Demographics
NPI:1497764260
Name:EDWARDS, AMY LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:EDWARDS
Suffix:
Gender:F
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 1:9125 CALVERT RD
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-6452
Mailing Address - Country:US
Mailing Address - Phone:972-922-9561
Mailing Address - Fax:
Practice Address - Street 1:1405 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-2231
Practice Address - Country:US
Practice Address - Phone:972-923-7178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02832363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281894003Medicaid
TXPA02832OtherPHYSICIAN ASSISTANTS
TX281894001Medicaid
TX281894002Medicaid
TXTXB125312Medicare PIN
TXTXB125311Medicare PIN
TX281894003Medicaid