Provider Demographics
NPI:1689794133
Name:EDWARDS, RICHARD KEVIN (APRN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KEVIN
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3565
Mailing Address - Country:US
Mailing Address - Phone:203-882-2066
Mailing Address - Fax:203-882-2074
Practice Address - Street 1:50 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3565
Practice Address - Country:US
Practice Address - Phone:203-882-2066
Practice Address - Fax:203-882-2074
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00221363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008017637Medicaid