Kenneth Anthony Edwards, PH.D.
Individual provider Active NPI Forensic Psychologist · Mound House, NV
NPI 1003939356 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1003939356
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Forensic Psychologist 103TF0200X
- License
- 1167 (WI)
- Practice address
- 10116 Highway 50 East
Suite 101
Mound House, NV 89706 - Phone
- (775) 841-3116
- NPI assigned
- Apr 9, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY0409 | NV | MD | Psychologist |
| 1167 | WI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| E&a Behavioral and Mental Health Services, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY0409 | NV | |
| Psychologist | 103T00000X | 1167 | WI | |
| Adult Development & Aging Psychologist | 103TA0700X | PY0409 | NV | |
| Adult Development & Aging Psychologist | 103TA0700X | 1167 | WI | |
| Cognitive & Behavioral Psychologist | 103TB0200X | PY0409 | NV | |
| Cognitive & Behavioral Psychologist | 103TB0200X | 1167 | WI | |
| Forensic Psychologist | 103TF0200X | PY0409 | NV | |
| Forensic Psychologist | 103TF0200X | 1167 | WI | Yes |
Addresses
Primary practice location
10116 Highway 50 East
Suite 101
Mound House, NV 89706
Mailing address
PO Box 115
Dayton, NV 89403-0115
Phone (775) 841-3116
Other providers in Mound House, NV
All providers in Mound House, NV · Forensic Psychologist in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.