Provider Demographics
NPI:1659587707
Name:EDNIE, KATHRYN JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:JEAN
Last Name:EDNIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1200 NE 55TH BLVD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-2783
Mailing Address - Country:US
Mailing Address - Phone:352-264-8276
Mailing Address - Fax:352-264-8305
Practice Address - Street 1:1200 NE 55TH BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-2783
Practice Address - Country:US
Practice Address - Phone:352-264-8276
Practice Address - Fax:352-264-8305
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010404682084F0202X
FLME400382084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry