MEDICARE: KAY KAREN REDWINE RN CNS APN

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	363LG0600X	Gerontology Nurse Practitioner	223294	TX

General Provider Information

NPI Number	:	1801991518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY KAREN REDWINE RN CNS APN

Provider Business Mailing Address
First Line	:	703 MCKINNEY AVENUE
Second Line	:	SUITE 433
City	:	DALLAS
State	:	TX
Zip	:	75202
Country	:	US
Telephone Number	:	214-754-8700
Fax Number	:	214-271-4659

Provider Business Practice Location Address
First Line	:	703 MCKINNEY AVENUE
Second Line	:	SUITE 433
City	:	DALLAS
State	:	TX
Zip	:	75202
Country	:	US
Telephone Number	:	214-754-8700
Fax Number	:	214-271-4659

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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