Provider Demographics
NPI:1598218810
Name:EDWARDS, VERONICA (FNP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1223
Mailing Address - Country:US
Mailing Address - Phone:502-535-2158
Mailing Address - Fax:
Practice Address - Street 1:313 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1223
Practice Address - Country:US
Practice Address - Phone:502-535-2158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28223288A363LF0000X, 364SF0001X
KY3012015363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598218810OtherNPI