Kevin James Edwards, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP3464 Issued in MN

Practice address

13045 Falcon Dr Ste 100
Baxter, MN 56425-4201

Phone

(218) 829-9307

Fax

(218) 829-7649

NPI assigned

Mar 19, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Nystrom and Associates LTDGroup PAC ID 6406752492, 590 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Nystrom & Associates, LTD

  • Clinical Social Worker
  • New Brighton, MN
  • NPI 1396750188
  Medicare reassignment Care Compare group NPD
• St. Joseph'S Medical Center

  • General Acute Care Hospital
  • Brainerd, MN
  • NPI 1568415974
  Medicare reassignment NPD
• St Joseph'S Medical Center

  • Multi-Specialty Clinic/Center
  • Staples, MN
  • NPI 1538916101
  NPD
• Family Support Services Inc.

  • Mental Health Counselor
  • New Brighton, MN
  • NPI 1467549220
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763683200000",
    "number": "1053435743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789",
            "telephone_number": "651-628-9566",
            "fax_number": "651-628-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13045 FALCON DR STE 100",
            "city": "BAXTER",
            "state": "MN",
            "postal_code": "564254201",
            "telephone_number": "218-829-9307",
            "fax_number": "218-829-7649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "KEVIN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-19",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP3464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassandra Maria Dutton, DC
• Kimberly Jeane Dwinnell-Dillon, L.I.C.S.W
• Jessica Ann Eastman, CNP
• Dawn Marie Eckstrom
• Edgewood Baxter LLC
• Elite Sleep Solutions, LLC
• Marilyn Elizabeth Ellis
• Amber Endres, LGSW
• McKenzie Lou Engebretson
• Amy Elise Engen

• Clinical Psychologist in Baxter, MN
• Providers in Baxter, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.