Provider Demographics
NPI:1104441914
Name:EDWARDS, JOSEPH CHRISTOPHER (APRN STUDENT)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHRISTOPHER
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:APRN STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3681 BRIARCLIFF TRCE
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7602
Mailing Address - Country:US
Mailing Address - Phone:270-871-5505
Mailing Address - Fax:
Practice Address - Street 1:710 S GREEN RIVER RD STE 1
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4104
Practice Address - Country:US
Practice Address - Phone:812-901-5780
Practice Address - Fax:877-358-9237
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1086308390200000X
KY3015684363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program