Provider Demographics
NPI:1649892845
Name:EDWARDS, KIMBERLY (RN)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 GREENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-6718
Mailing Address - Country:US
Mailing Address - Phone:786-547-6282
Mailing Address - Fax:
Practice Address - Street 1:4334 GREENWOOD LN
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-6718
Practice Address - Country:US
Practice Address - Phone:786-547-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX799388163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse