MEDICARE: KATHLEEN REDDEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1282	OK

General Provider Information

NPI Number	:	1104828524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN REDDEN PA-C

Provider Business Mailing Address
First Line	:	910 E REDD RD
Second Line	:	#K522
City	:	EL PASO
State	:	TX
Zip	:	79912-7359
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 2496 RICKER ROAD
Second Line	:	SFMC
City	:	FT. BLISS
State	:	TX
Zip	:	79916
Country	:	US
Telephone Number	:	915-569-2930
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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Directions to “ KATHLEEN REDDEN PA-C” Practice Location

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