Provider Demographics
NPI:1891423919
Name:EDWARDS, KIMBERLEY JOAN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:JOAN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:
Other - Last Name:STOKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 CHASTAIN PL
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4300
Mailing Address - Country:US
Mailing Address - Phone:478-461-4110
Mailing Address - Fax:
Practice Address - Street 1:165 N PARK TRL
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6500
Practice Address - Country:US
Practice Address - Phone:770-506-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117950363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner