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General NPI Number Information
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NPI Number | 1831661800
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Entity Type | Individual
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Provider Name | LAKISHA REDMOND RMA, CCMA, AHI, PBT
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Gender | Female
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Dates
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Enumeration Date | 01/01/2019
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 12320 ASHLEY DR STE D
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City | GULFPORT
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State | MS
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Zip | 39503
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Country | US
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Telephone | 228-609-9752
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Fax | 888-964-2655
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Provider Business Mailing Address
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Address Line | 12320 ASHLEY DR STE D
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City | GULFPORT
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State | MS
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Zip | 39503
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Country | US
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Telephone | 228-609-9752
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Fax | 888-964-2655
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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 | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | 2591601
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number | 2591601
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | 65804
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 246RM2200X
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Taxonomy Name | Medical Laboratory Technician
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License Number | 25475911
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License Number State | MS
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