Healthcare Provider Details

I. General information

NPI: 1205245511
Provider Name (Legal Business Name): KAYLIN REDINGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KAYLIN PETROSKY

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 DOLPHIN DR
JACKSONVILLE NC
28546
US

IV. Provider business mailing address

308 DOLPHIN DR
JACKSONVILLE NC
28546-5266
US

V. Phone/Fax

Practice location:
  • Phone: 910-346-2273
  • Fax: 910-346-1907
Mailing address:
  • Phone: 910-346-2273
  • Fax: 910-346-1907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05158
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: