Provider Demographics
NPI:1215684147
Name:EDWARDS, KAYLAN MICHELLE (NP)
Entity type:Individual
Prefix:
First Name:KAYLAN
Middle Name:MICHELLE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2027 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4603
Mailing Address - Country:US
Mailing Address - Phone:702-338-8990
Mailing Address - Fax:
Practice Address - Street 1:4150 REGENTS PARK ROW STE 280
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1417
Practice Address - Country:US
Practice Address - Phone:858-280-3166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily