Provider Demographics
NPI:1750272076
Name:EDWARDS, KATHERINE JORDAN
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JORDAN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:CA
Mailing Address - Zip Code:94937-0401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 TROSSACH WAY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:CA
Practice Address - Zip Code:94937
Practice Address - Country:US
Practice Address - Phone:415-912-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99489225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist