Provider Demographics
NPI:1457702763
Name:EDWARDS, KANDIS MAY
Entity type:Individual
Prefix:
First Name:KANDIS
Middle Name:MAY
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANDIS
Other - Middle Name:MAY
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:750 N FREEDOM BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1677
Mailing Address - Country:US
Mailing Address - Phone:801-373-4760
Mailing Address - Fax:801-373-0639
Practice Address - Street 1:1726 BUCKLEY LN
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-5031
Practice Address - Country:US
Practice Address - Phone:801-373-6562
Practice Address - Fax:801-375-9225
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool