Provider Demographics
NPI:1366270266
Name:EDWARDS, KISHA (NP)
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5510 S EAST ST STE H
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1939
Mailing Address - Country:US
Mailing Address - Phone:317-924-8425
Mailing Address - Fax:317-924-8424
Practice Address - Street 1:5510 S EAST ST STE H
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1939
Practice Address - Country:US
Practice Address - Phone:317-924-8425
Practice Address - Fax:317-924-8424
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71015530A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily