Provider Demographics
NPI:1336525989
Name:EDWARDS, KEM
Entity Type:Individual
Prefix:
First Name:KEM
Middle Name:
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 1:3030 COVINGTON PIKE
Mailing Address - Street 2:SUITE 241
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-5048
Mailing Address - Country:US
Mailing Address - Phone:901-409-1785
Mailing Address - Fax:
Practice Address - Street 1:3030 COVINGTON PIKE
Practice Address - Street 2:SUITE 241
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-5048
Practice Address - Country:US
Practice Address - Phone:901-409-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental IllnessGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
No251V00000XAgenciesVoluntary or Charitable
No347C00000XTransportation ServicesPrivate Vehicle