Provider Demographics
NPI:1598410136
Name:EDWARDS, PRISCILLA ANN
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 KLEINPETER RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70811-1327
Mailing Address - Country:US
Mailing Address - Phone:225-603-2764
Mailing Address - Fax:
Practice Address - Street 1:6320 KLEINPETER RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70811-1327
Practice Address - Country:US
Practice Address - Phone:225-603-2764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)