Provider Demographics
NPI:1265160642
Name:EDWARDS, KATRINA LAVETTE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LAVETTE
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 1:154 BROOKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-5715
Mailing Address - Country:US
Mailing Address - Phone:256-225-4371
Mailing Address - Fax:
Practice Address - Street 1:154 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5715
Practice Address - Country:US
Practice Address - Phone:256-225-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-171946163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse