Provider Demographics
NPI:1013107366
Name:EDGAR, JENNIFER SHAWN (APRN, BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SHAWN
Last Name:EDGAR
Suffix:
Gender:F
Credentials:APRN, BC
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 639295 DEPT 93394
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:248-266-4200
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:2452 SIR BARTON WAY STE 303
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2549
Practice Address - Country:US
Practice Address - Phone:248-266-4200
Practice Address - Fax:855-618-6655
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704197458363LG0600X
KY3016996363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology