Healthcare Provider Details

I. General information

NPI: 1902471006
Provider Name (Legal Business Name): ERIKA DIONNE REDD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E NORTHSIDE DR STE 220
JACKSON MS
39211-5503
US

IV. Provider business mailing address

216 STONEYBROOK DR
BRANDON MS
39042-3500
US

V. Phone/Fax

Practice location:
  • Phone: 601-298-4173
  • Fax:
Mailing address:
  • Phone: 601-331-3394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number904550
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: