Provider Demographics
NPI:1386092005
Name:EDWARDS, NEICA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:NEICA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:NEICA
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5404 SW LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9521
Mailing Address - Country:US
Mailing Address - Phone:580-355-5242
Mailing Address - Fax:580-585-5553
Practice Address - Street 1:3811 W GORE BLVD STE 10
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6328
Practice Address - Country:US
Practice Address - Phone:580-510-7076
Practice Address - Fax:580-510-7081
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201888363LF0000X
OK0109332163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse