Healthcare Provider Details

I. General information

NPI: 1780682807
Provider Name (Legal Business Name): TERESA B. REDMOND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 19TH AVE
MERIDIAN MS
39301-4116
US

IV. Provider business mailing address

PO BOX 5183
MERIDIAN MS
39302-5183
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-4415
  • Fax: 601-703-4418
Mailing address:
  • Phone: 601-703-9506
  • Fax: 601-703-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR504955
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License NumberR504955
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: