Healthcare Provider Details

I. General information

NPI: 1700471174
Provider Name (Legal Business Name): BRIANNA SUE REDMAN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2021
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9217 US HIGHWAY 42 STE E
PROSPECT KY
40059-8854
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6879
US

V. Phone/Fax

Practice location:
  • Phone: 502-228-1312
  • Fax: 502-228-5541
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015929
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF03210319
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: