=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033094362
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDEEMED MENTAL HEALTH AND RECOVERY, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2025
-----------------------------------------------------
Last Update Date | 08/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 545 BRENT LN # 56
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-512-8633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 545 BRENT LN # 56
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32503-2003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-512-8633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. SEAN RYAN
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 850-512-8633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------