Provider Demographics
NPI:1902816549
Name:EDWARDS, WAYNE R (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:R
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 QUAIL WALK
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1430
Mailing Address - Country:US
Mailing Address - Phone:606-253-3045
Mailing Address - Fax:606-432-4050
Practice Address - Street 1:6500 HIGHWAY 645
Practice Address - Street 2:SUITE 110
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224
Practice Address - Country:US
Practice Address - Phone:606-534-4002
Practice Address - Fax:606-534-4007
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34226207QA0000X, 207Q00000X, 207QA0401X, 207QA0505X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000297028OtherANTHEM BC/BS
KY64050271Medicaid
KY0371318Medicare ID - Type Unspecified
KY000000297028OtherANTHEM BC/BS
KY0675517Medicare ID - Type Unspecified
KYH35616Medicare UPIN
KY0675717Medicare ID - Type Unspecified
KY0675617Medicare ID - Type Unspecified
KY0366423Medicare ID - Type Unspecified
KY0653318Medicare ID - Type Unspecified
KY0675417Medicare ID - Type Unspecified