Healthcare Provider Details

I. General information

NPI: 1740536804
Provider Name (Legal Business Name): JADON LEE REDINGTON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 PARK MEADOWS DR SUITE 200
LONETREE CO
80124-2742
US

IV. Provider business mailing address

PO BOX 172263
DENVER CO
80217-2263
US

V. Phone/Fax

Practice location:
  • Phone: 303-367-2225
  • Fax: 303-343-8702
Mailing address:
  • Phone: 248-983-5308
  • Fax: 720-360-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0003494
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: