Provider Demographics
NPI:1124547666
Name:EDGERLY, KAEAI (NP-C, APRN)
Entity type:Individual
Prefix:
First Name:KAEAI
Middle Name:
Last Name:EDGERLY
Suffix:
Gender:F
Credentials:NP-C, APRN
Other - Prefix:
Other - First Name:KAEAI
Other - Middle Name:
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C, APRN
Mailing Address - Street 1:55 DAMONTE RANCH PKWY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-2996
Mailing Address - Country:US
Mailing Address - Phone:845-249-5500
Mailing Address - Fax:
Practice Address - Street 1:55 DAMONTE RANCH PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-2996
Practice Address - Country:US
Practice Address - Phone:845-249-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily