Healthcare Provider Details

I. General information

NPI: 1023862828
Provider Name (Legal Business Name): RANDI RENE REDDING APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6407 S COOPER ST STE 117
ARLINGTON TX
76001-5813
US

IV. Provider business mailing address

8600 ELMWOOD DR
BENBROOK TX
76116-7671
US

V. Phone/Fax

Practice location:
  • Phone: 817-472-7601
  • Fax:
Mailing address:
  • Phone: 904-655-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1143101
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: