Provider Demographics
NPI:1154624492
Name:EDWARDS, MARY LEE (APRN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LEE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:989 GOVERNORS LN STE 240
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1175
Mailing Address - Country:US
Mailing Address - Phone:859-338-3958
Mailing Address - Fax:859-368-8135
Practice Address - Street 1:989 GOVERNORS LN STE 240
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1175
Practice Address - Country:US
Practice Address - Phone:859-338-3958
Practice Address - Fax:859-368-8135
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2024-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3006711363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100176800Medicaid