Provider Demographics
NPI:1316656051
Name:EDWARDS, MADISON ANNE (APRN)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:ANNE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:ANNE
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2907 N 39TH TER
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1811
Mailing Address - Country:US
Mailing Address - Phone:816-262-2066
Mailing Address - Fax:
Practice Address - Street 1:1115 N BELT HWY
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2410
Practice Address - Country:US
Practice Address - Phone:816-271-7077
Practice Address - Fax:816-271-4998
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022033235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily