Individual
JERRY KEITH EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3515 W MARKET ST STE 200, GREENSBORO, NC 27403-4442
(336) 660-5520
(336) 660-5539
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5006584
NC
Other
Enumeration date
11/05/2013
Last updated
06/16/2022
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