Individual
KENT EDWARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
11488 SUGAR CREEK RD, BENTON, IL 62812-4315
(618) 927-1610
Mailing address
11488 SUGAR CREEK RD, BENTON, IL 62812-4315
(618) 927-1610
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209016765
IL
Other
Enumeration date
10/30/2017
Last updated
10/30/2017
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