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NPI Code Detail

MEDICARE: JANA LEIGH REDWINE PA-C

MEDICARE: JANA LEIGH REDWINE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA04272TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00277809OTHERTXMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
28N7639OTHERTXBLUE CROSS/BLUE SHIELD TX

General Provider Information

NPI Number : 1356396808
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANA LEIGH REDWINE PA-C
Provider Business Mailing Address
First Line : 301 UTICA AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79416-3111
Country : US
Telephone Number : 806-797-4985
Fax Number : 806-744-7545
Provider Business Practice Location Address
First Line : 301 UTICA AVE
Second Line :
City : LUBBOCK
State : TX
Zip : 79416-3111
Country : US
Telephone Number : 806-797-4985
Fax Number : 806-744-7545
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 02/04/2022

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Directions to “ JANA LEIGH REDWINE PA-C” Practice Location

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