Healthcare Provider Details

I. General information

NPI: 1679577662
Provider Name (Legal Business Name): ANNA TALLEY REDMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE STE 6A
PINE BLUFF AR
71603-6963
US

IV. Provider business mailing address

1801 W 40TH AVE STE 6A
PINE BLUFF AR
71603-6963
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-9373
  • Fax: 870-541-0109
Mailing address:
  • Phone: 870-541-9373
  • Fax: 870-541-0109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC6658
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: