Provider Demographics
NPI:1598319667
Name:EDINBYRD, CAROL
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:EDINBYRD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRIDGING
Other - Middle Name:
Other - Last Name:COMMUNITES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2715 POTEET DR
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4943
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2715 POTEET DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-4943
Practice Address - Country:US
Practice Address - Phone:214-244-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-27
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator