Individual
KELLY JEAN EDGE
Active
Individual
KELLY JEAN EDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CGC
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
74000347A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001424534
ANTHEM PTAN
IN
01
—
1102194716
ANTHEM PTAN
IN
05
—
300041098
—
IN
Enumeration date
06/09/2020
Last updated
02/21/2025
Update your record
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