MEDICARE: CRYSTAL REDMOND

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
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1700479649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL REDMOND

Provider Business Mailing Address
First Line	:	177 WINDY RIDGE LN
Second Line	:
City	:	ALBRIGHT
State	:	WV
Zip	:	26519-7687
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	177 WINDY RIDGE LN
Second Line	:
City	:	ALBRIGHT
State	:	WV
Zip	:	26519-7687
Country	:	US
Telephone Number	:	304-216-4544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	02/11/2021

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Directions to “ CRYSTAL REDMOND ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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