1487637484 NPI number — MS. JANICE CAROL REDMOND CRNA

Table of content: MS. JANICE CAROL REDMOND CRNA (NPI 1487637484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487637484 NPI number — MS. JANICE CAROL REDMOND CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDMOND
Provider First Name:
JANICE
Provider Middle Name:
CAROL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCONNELL
Provider Other First Name:
CAROL
Provider Other Middle Name:
REDMOND
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487637484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2116 MEMORIAL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37664-2629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-646-2424
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2116 MEMORIAL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37664-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-646-2424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  APN0000005996 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: 0024164113 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AN0939 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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