Provider Demographics
NPI:1427246636
Name:EDWARDS, STEVEN DEVON (PA-C)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DEVON
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CLARA BARTON BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5755
Mailing Address - Country:US
Mailing Address - Phone:972-272-6554
Mailing Address - Fax:
Practice Address - Street 1:601 CLARA BARTON BLVD STE 340
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5755
Practice Address - Country:US
Practice Address - Phone:972-272-6554
Practice Address - Fax:972-272-5969
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L23855Medicare PIN
TX8K0798Medicare PIN
TX8K0837Medicare PIN