Active NPI
Kelly L Edwards, NP
- Adult Health Nurse Practitioner
- Youngsville, NY
National Provider Identifier
1952747271
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- F306511-1
- Practice address
- 4054 State Route 52
Youngsville, NY 12791-0595 - Phone
- (845) 482-4800
- NPI assigned
- May 14, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | F306511-1 | NY | Primary |
Addresses
Primary practice location
4054 State Route 52
Youngsville, NY 12791-0595
Mailing address
PO Box 595
Youngsville, NY 12791-0595
Phone (845) 482-4800
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
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F306511-1 | NY | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476748800000",
"number": "1952747271",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 595",
"city": "YOUNGSVILLE",
"state": "NY",
"postal_code": "127910595",
"telephone_number": "845-482-4800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4054 STATE ROUTE 52",
"city": "YOUNGSVILLE",
"state": "NY",
"postal_code": "127910595",
"telephone_number": "845-482-4800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDS",
"first_name": "KELLY",
"middle_name": "L",
"credential": "NP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-05-14",
"last_updated": "2016-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "NY",
"license": "F306511-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Youngsville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.