Healthcare Provider Details

I. General information

NPI: 1033031729
Provider Name (Legal Business Name): ROY REDNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 HIGHWAY 95A SUITE 802
FERNLEY NV
89408
US

IV. Provider business mailing address

720 S MAIN ST STE A
YERINGTON NV
89447-2474
US

V. Phone/Fax

Practice location:
  • Phone: 775-575-6191
  • Fax:
Mailing address:
  • Phone: 775-463-6597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: