Provider Demographics
NPI:1730651456
Name:EDWARDS, CASSONDRA (FNP)
Entity Type:Individual
Prefix:
First Name:CASSONDRA
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 1:203 TOMMY STALNAKER DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8960
Mailing Address - Country:US
Mailing Address - Phone:478-333-3711
Mailing Address - Fax:478-333-6681
Practice Address - Street 1:203 TOMMY STALNAKER DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8960
Practice Address - Country:US
Practice Address - Phone:478-333-3711
Practice Address - Fax:478-333-6681
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA205449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily