Provider Demographics
NPI:1043945538
Name:EDWARDS, JAMIE (CRNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:EDWARDS
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 1:1118 ROSS CLARK CIR STE 402
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3002
Mailing Address - Country:US
Mailing Address - Phone:334-673-3633
Mailing Address - Fax:334-836-2894
Practice Address - Street 1:1118 ROSS CLARK CIR STE 402
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3002
Practice Address - Country:US
Practice Address - Phone:334-673-3633
Practice Address - Fax:334-836-2894
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF06221056363LW0102X
AL1-140317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health