Basic Information
| Provider Information | |||||||||
| NPI: | 1871629840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EDWARDS | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | LOUELLA | ||||||||
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| Credential: | PMH- NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9525 KATY FWY | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770241407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134639449 | ||||||||
| FaxNumber: | 7134637181 | ||||||||
| Practice Location | |||||||||
| Address1: | 9525 KATY FWY | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770241407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134639449 | ||||||||
| FaxNumber: | 7134637181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 10/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 548607 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 165447702 | 05 | TX | MEDICAID | P00235651 | 01 | TX | RAILROAD MEDICARE | OTHER |