Healthcare Provider Details

I. General information

NPI: 1730008129
Provider Name (Legal Business Name): BRANDON REDD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5882 S MYTHICAL LN
ST GEORGE UT
84790-4124
US

IV. Provider business mailing address

5882 S MYTHICAL LN
ST GEORGE UT
84790-4124
US

V. Phone/Fax

Practice location:
  • Phone: 435-704-6739
  • Fax:
Mailing address:
  • Phone: 435-704-6739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number7862-6574-0337
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: