Provider Demographics
NPI:1669008926
Name:EDWARDS, KRISTINE (NP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-2921
Mailing Address - Country:US
Mailing Address - Phone:765-491-2570
Mailing Address - Fax:
Practice Address - Street 1:723 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-2921
Practice Address - Country:US
Practice Address - Phone:765-491-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704279184NSA1910T363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily