Individual provider Active NPI

Kaelyn Grace Edwards

  • Student in an Organized Health Care Education/Training Program
  • San Antonio, TX
National Provider Identifier
1609700095
Registry record updated Jun 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
45339 Issued in TX
Practice address
12777 W Ih 10
San Antonio, TX 78230-1014
Phone
(210) 558-3027
NPI assigned
Jun 10, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 45339 TX Primary

Addresses

Primary practice location

12777 W Ih 10
San Antonio, TX 78230-1014

Mailing address

12034 Vista Nogal St
San Antonio, TX 78213-1240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1781049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781049600000",
    "number": "1609700095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12034 VISTA NOGAL ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12777 W IH 10",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782301014",
            "telephone_number": "210-558-3027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "KAELYN",
        "middle_name": "GRACE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-06-10",
        "last_updated": "2026-06-10",
        "certification_date": "2026-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "45339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2026; 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.