Individual
JORDAN LEE EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
105 CREEKSIDE OFFICE DR, WENTZVILLE, MO 63385-3289
(636) 625-5200
Mailing address
315 VININGS BLVD, O FALLON, MO 63366-7582
(870) 634-6883
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2019026971
MO
Other
Enumeration date
10/15/2019
Last updated
10/22/2019
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