Individual
KATHRYN GAIL EDWARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
801 CHERRY ST, ST 400, LB#49, FORT WORTH, TX 76102-6803
(682) 885-6800
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
0101239704
VA
208000000X
Pediatrics Physician
Primary
N1620
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010260221
—
VA
05
—
205616001
—
TX
01
—
205616002
CSHCN
TX
01
—
8CB421
BCBS
TX
Enumeration date
05/23/2006
Last updated
08/03/2012
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