Provider Demographics
NPI:1649434754
Name:EDWARDS, BETHANY JANETTE (FNP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:JANETTE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7215 S SIWELL RD
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9776
Mailing Address - Country:US
Mailing Address - Phone:601-373-2204
Mailing Address - Fax:601-373-4413
Practice Address - Street 1:7215 S SIWELL RD
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9776
Practice Address - Country:US
Practice Address - Phone:601-373-2204
Practice Address - Fax:601-373-4413
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS098-23-097Medicaid
MS3021503509Medicare PIN
MS098-23-097Medicaid