Healthcare Provider Details

I. General information

NPI: 1386290369
Provider Name (Legal Business Name): JO'NIECE PHILLIPS REDMOND DNP, APRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N PAULINE ST
MEMPHIS TN
38104-1005
US

IV. Provider business mailing address

116 N PAULINE ST
MEMPHIS TN
38104-1005
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax: 901-577-7414
Mailing address:
  • Phone: 901-523-8990
  • Fax: 15-777-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26399
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number26399
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number905360
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number26399
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: