Provider Demographics
NPI:1558759225
Name:EDWARDS, NEDRA M (APRN)
Entity Type:Individual
Prefix:
First Name:NEDRA
Middle Name:M
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 SE DEBELL AVE
Mailing Address - Street 2:BLDG A
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2343
Mailing Address - Country:US
Mailing Address - Phone:918-287-1310
Mailing Address - Fax:918-287-1312
Practice Address - Street 1:701 LEAHY AVE
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-3235
Practice Address - Country:US
Practice Address - Phone:918-287-1310
Practice Address - Fax:918-287-1727
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK68861363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner