Provider Demographics
NPI:1912484932
Name:EDWARDS, DARA BREON (NP)
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:BREON
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 AMOROSO DR
Mailing Address - Street 2:
Mailing Address - City:IOWA COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:77583-1190
Mailing Address - Country:US
Mailing Address - Phone:832-865-2821
Mailing Address - Fax:
Practice Address - Street 1:8498 S SAM HOUSTON PKWY E STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77075-4892
Practice Address - Country:US
Practice Address - Phone:832-937-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily