Healthcare Provider Details

I. General information

NPI: 1649626946
Provider Name (Legal Business Name): NIKIESHA THOMAS REDUS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKIESHA SHAWNTE THOMAS

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3940 SANDPIPER AVE
MERCED CA
95340-8372
US

IV. Provider business mailing address

737 W CHILDS AVE
MERCED CA
95341-6805
US

V. Phone/Fax

Practice location:
  • Phone: 866-682-4842
  • Fax:
Mailing address:
  • Phone: 866-682-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: