Vanzanell Edwards, ADMINISTOR

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

136989 Issued in TX

Practice address

7801 Marlborough Dr W
Fort Worth, TX 76134-4309

Phone

(817) 568-1445

Fax

(817) 782-9304

NPI assigned

Nov 24, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1385251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385251200000",
    "number": "1831529080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7801 MARLBOROUGH DR W",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761344309",
            "telephone_number": "817-568-1445",
            "fax_number": "817-782-9304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7801 MARLBOROUGH DR W",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761344309",
            "telephone_number": "817-568-1445",
            "fax_number": "817-782-9304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "VANZANELL",
        "credential": "ADMINISTOR",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-24",
        "last_updated": "2013-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "TX",
            "license": "136989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "75-2645166",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADMINISTOR",
            "identifier": "75-2645166",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Russell Benjamin Edwards, DO
• Stephanie Heliot Edwards, PA-C
• Toby Reed Edwards, OTA
• Torrie Edwards, FNP
• Tyraeia Brooke Edwards, PHARM.D
• Victoria Edwards
• Dominique Ee
• Frood Eelani, DO
• Eem Enterprises, Inc.
• Shayna Dae Egan

• Adult Mental Health Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Adult Mental Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2013; 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.