Kevin Donald Edwards, PEER SUPPORT

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

CG61078770 Issued in WA

Practice address

2222 N Monroe St
Spokane, WA 99205-4545

Phone

(509) 413-2950

NPI assigned

Apr 19, 2021

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Revive Counseling Spokane, PLLC

  • Community/Behavioral Health Agency
  • Spokane, WA
  • NPI 1306321567
  NPD (past)
• Revive Counseling Spokane, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Spokane, WA
  • NPI 1316477805
  NPD (past)

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

{
    "created_epoch": "1618790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1205417490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 N MONROE ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992054545",
            "telephone_number": "509-413-2950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 N MONROE ST",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992054545",
            "telephone_number": "509-413-2950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "KEVIN",
        "middle_name": "DONALD",
        "credential": "PEER SUPPORT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-04-19",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "WA",
            "license": "CG61078770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alcia Delaney Edwards-Richards, M.D.
• David R Edwards, MS, LMFT
• Jessica Elizabeth Edwards
• John Edwards
• John H. Edwards, M.D.
• Kyle Edwards, M.D.
• Laurel Gay Edwards, MASTERS IN EDUCATION
• Makia Edwards
• Marlyse Edwards, CWLC, MSW
• Melanie J. L. Edwards, MA, LMHC

• Peer Specialist in Spokane, WA
• Providers in Spokane, WA by specialty
• Peer Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.