Provider Demographics
NPI:1265901219
Name:EDWARDS, MYRIAM FILLION
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:FILLION
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 1:3525 TWIN PINES DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-1126
Mailing Address - Country:US
Mailing Address - Phone:281-224-0469
Mailing Address - Fax:
Practice Address - Street 1:604 SOUTHEAST PKWY
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3453
Practice Address - Country:US
Practice Address - Phone:817-270-2320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant