Suzan Tamesha Edwards, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

48988 Issued in WY

Practice address

507 Ventura Ave
Gillette, WY 82716-2292

NPI assigned

Apr 4, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

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

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699228800000",
    "number": "1740742006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 VENTURA AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827162292",
            "telephone_number": "754-235-7190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 VENTURA AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827162292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "SUZAN",
        "middle_name": "TAMESHA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-04",
        "last_updated": "2023-11-06",
        "certification_date": "2023-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "WY",
            "license": "48988",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WY",
            "license": "48988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Mary Dvorak
• Codye Kaylynn Easterling
• Suzanne Marie Eastman
• Rebecca Jo Eden, ISC
• Rebecca Edwards, CRNA
• William Pell Egbert, MD
• Alphonse Eid
• Ekstroms Nursing, LLC
• Elevation Medical Imaging Gillette
• Employment Testing Services

• All providers in Gillette, WY
• Family Nurse Practitioner in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.