Healthcare Provider Details

I. General information

NPI: 1558644377
Provider Name (Legal Business Name): KRISTY MARY REDMOND PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 BROAD ST
PLATTSBURGH NY
12901-3315
US

IV. Provider business mailing address

20 AMPERSAND DR
PLATTSBURGH NY
12901-6500
US

V. Phone/Fax

Practice location:
  • Phone: 518-563-8000
  • Fax: 518-563-8261
Mailing address:
  • Phone: 518-561-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number576713
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: