Provider Demographics
NPI:1922782259
Name:EDWARDS, KATRINA C
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:C
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 COMPASSION DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-3056
Mailing Address - Country:US
Mailing Address - Phone:304-886-6921
Mailing Address - Fax:
Practice Address - Street 1:155 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3311
Practice Address - Country:US
Practice Address - Phone:305-202-4854
Practice Address - Fax:304-305-1597
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV31384164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse