Provider Demographics
NPI:1710583448
Name:EDWARDS, AMBER DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6102 FIRETHORNE LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-9117
Mailing Address - Country:US
Mailing Address - Phone:919-454-9484
Mailing Address - Fax:
Practice Address - Street 1:16645 BIRKDALE COMMONS PKWY STE 100A
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5669
Practice Address - Country:US
Practice Address - Phone:704-863-4878
Practice Address - Fax:704-801-1391
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC363AS0400X, 363A00000X
NCLAT-40222081S0010X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine