Provider Demographics
NPI:1548725310
Name:EDWARDS, NAKIA ANTOINETTE
Entity type:Individual
Prefix:
First Name:NAKIA
Middle Name:ANTOINETTE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAKIA
Other - Middle Name:ANTOINETTE
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3055 FLOYD AVE
Mailing Address - Street 2:APT 245
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7932
Mailing Address - Country:US
Mailing Address - Phone:334-421-7476
Mailing Address - Fax:
Practice Address - Street 1:1541 FLORIDA AVE STE 100
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4438
Practice Address - Country:US
Practice Address - Phone:209-577-3388
Practice Address - Fax:209-338-0024
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-141525363LP2300X
CANP95011384363LP2300X
VT101.0137900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner