Provider Demographics
NPI:1649825704
Name:EDWARDS, NATASHA BROOKE (APRN-FNP)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:BROOKE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 PROVINE PL APT 1613
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3968
Mailing Address - Country:US
Mailing Address - Phone:318-955-1574
Mailing Address - Fax:
Practice Address - Street 1:2705 HIGHWAY 28 E STE B
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-5712
Practice Address - Country:US
Practice Address - Phone:318-704-6770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily