Individual
MS. PETRA EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3555 HARDEN STREET EXT STE 141, COLUMBIA, SC 29203-6894
(803) 434-4300
(803) 434-4351
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
19767
SC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
19767
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3459
—
SC
Enumeration date
10/01/2015
Last updated
12/06/2024
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