Provider Demographics
NPI:1598010852
Name:EDWARDS, HOLLIS VERONICA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:HOLLIS
Middle Name:VERONICA
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 1:1904 MEADOWGATE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1122
Mailing Address - Country:US
Mailing Address - Phone:502-298-7854
Mailing Address - Fax:
Practice Address - Street 1:550 S JACKSON ST FL 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-588-4521
Practice Address - Fax:502-588-9542
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007580363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100211750Medicaid
KYK054931Medicare PIN
KY7100211750Medicaid