Provider Demographics
NPI:1851053185
Name:NIKITA R EDMONDS
Entity Type:Organization
Organization Name:NIKITA R EDMONDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:901-444-1083
Mailing Address - Street 1:1138 N GERMANTOWN PKWY # 101-102
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5872
Mailing Address - Country:US
Mailing Address - Phone:901-444-1083
Mailing Address - Fax:
Practice Address - Street 1:1138 N GERMANTOWN PKWY # 101-102
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5872
Practice Address - Country:US
Practice Address - Phone:901-444-1083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty