Individual provider Active NPI

Lavondia Edwards, FNP

  • Family Nurse Practitioner
  • Saint Louis, MO
National Provider Identifier
1235460163
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2010001250 Issued in MO
Practice address
11133 Dunn Rd
Saint Louis, MO 63136-6119
Phone
(314) 653-5000
Fax
(314) 317-0606
NPI assigned
Jan 15, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2010001250 MO Primary
Registered Nurse 163W00000X 154318 MO

Addresses

Primary practice location

11133 Dunn Rd
Saint Louis, MO 63136-6119

Mailing address

12101 Woodcrest Executive Dr
Suite 210
Saint Louis, MO 63141-5047
Phone (314) 317-0600

Other identifiers 2

IdentifierTypeStateIssuer
1235460163MedicaidIL
1235460163MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100312000853 MO Practitioner - Nurse Practitioner 2567597792 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sound Physicians of Illinois LLCGroup PAC ID 1557533734, 193 clinicians
Southeastern Physician Services PCGroup PAC ID 0042307852, 591 clinicians

Practice addresses (Care Compare)

100 Medical PLZ
Lake Saint Louis, MO 63367-1366
Phone (636) 625-5200

11133 Dunn Rd
Saint Louis, MO 63136-6163
Phone (314) 653-4450

12303 De Paul Dr
Bridgeton, MO 63044-2512
Phone (314) 344-6000

6420 Clayton Rd
Richmond Heights, MO 63117-1811
Phone (314) 768-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
154318MOMDRegistered Nurse
2010001250MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Cogent Healthcare of Missouri, Inc CurrentSince Jan 1, 2022 Accepting new patients
Southeastern Physician Services PC CurrentSince Jul 1, 2016 Accepting new patients

Locations

12303 De Paul Dr
Bridgeton, MO 63044
Phone (314) 344-6360

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

300 1st Capitol Dr
Saint Charles, MO 63301
Phone (636) 669-2211

11133 Dunn Rd
Saint Louis, MO 63136
Phone (314) 653-5000

6420 Clayton Rd
Saint Louis, MO 63117
Phone (314) 768-8442

10 Hospital Dr
Saint Peters, MO 63376
Phone (636) 394-2522

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398124800000",
    "number": "1235460163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR",
            "address_2": "SUITE 210",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415047",
            "telephone_number": "314-317-0600",
            "fax_number": "314-317-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366119",
            "telephone_number": "314-653-5000",
            "fax_number": "314-317-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "LAVONDIA",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-15",
        "last_updated": "2014-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2010001250",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "154318",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235460163",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235460163",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.