Provider Demographics
NPI:1336858554
Name:EDWARDS, TARNISHA (CD, LC)
Entity Type:Individual
Prefix:
First Name:TARNISHA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:CD, LC
Other - Prefix:
Other - First Name:SHA'IRAH
Other - Middle Name:
Other - Last Name:KHYAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD, LC
Mailing Address - Street 1:151 HIGH RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-8909
Mailing Address - Country:US
Mailing Address - Phone:336-221-4311
Mailing Address - Fax:
Practice Address - Street 1:151 HIGH RIDGE CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-8909
Practice Address - Country:US
Practice Address - Phone:336-221-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No174N00000XOther Service ProvidersLactation Consultant, Non-RN