Provider Demographics
NPI:1003939356
Name:EDWARDS, KENNETH ANTHONY (PHD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ANTHONY
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-0115
Mailing Address - Country:US
Mailing Address - Phone:775-841-3116
Mailing Address - Fax:
Practice Address - Street 1:10116 HIGHWAY 50 EAST
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUND HOUSE
Practice Address - State:NV
Practice Address - Zip Code:89706
Practice Address - Country:US
Practice Address - Phone:775-841-3116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0409103T00000X, 103TA0700X, 103TB0200X, 103TF0200X
WI1167103T00000X, 103TA0700X, 103TB0200X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic