Provider Demographics
NPI:1649801598
Name:EDGE, CAROL DENISE (CRNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:DENISE
Last Name:EDGE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 COUNTY ROAD 85
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-6863
Mailing Address - Country:US
Mailing Address - Phone:334-221-5500
Mailing Address - Fax:
Practice Address - Street 1:34 TAYLOR RD N
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-6753
Practice Address - Country:US
Practice Address - Phone:334-323-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084327363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner