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General NPI Number Information
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NPI Number | 1528176807
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Entity Type | Individual
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Provider Name | SIMON P REDMON II FNP
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Gender | Male
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/20/2020
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Provider Practice Location Address
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Address Line | 215 BOBBY BEASLEY ST
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City | SEMINARY
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State | MS
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Zip | 39479-5501
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Country | US
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Telephone | 601-722-4300
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Fax | 601-722-9751
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Provider Business Mailing Address
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Address Line | 415 S 28TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7246
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Country | US
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Telephone | 601-722-4300
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Fax | 601-579-5240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R784157
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License Number State | MS
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