Basic Information
| Provider Information | |||||||||
| NPI: | 1871882795 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EDWARDS | ||||||||
| FirstName: | KENESSA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 CATHARINE STREET, P.O. BOX 550 | ||||||||
| Address2: | MID-HUDSON ANESTHESIOLOGISTS, PC | ||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668852318 | ||||||||
| FaxNumber: | 8457902675 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 DUBOIS STREET | ||||||||
| Address2: | ST. LUKES HOSPITAL | ||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455614400 | ||||||||
| FaxNumber: | 5853683219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2011 | ||||||||
| LastUpdateDate: | 10/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 273126-1 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 273126 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP2900X | 273126-1 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04501364 | 05 | NY | MEDICAID |