Provider Demographics
NPI:1316671076
Name:REDMON, NADIA CAROLINA
Entity type:Individual
Prefix:
First Name:NADIA
Middle Name:CAROLINA
Last Name:REDMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 N BECKLEY AVE STE 352
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1270
Mailing Address - Country:US
Mailing Address - Phone:469-981-2648
Mailing Address - Fax:888-570-2264
Practice Address - Street 1:1411 N BECKLEY AVE STE 352
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1270
Practice Address - Country:US
Practice Address - Phone:469-981-2648
Practice Address - Fax:888-570-2264
Is Sole Proprietor?:No
Enumeration Date:2022-07-10
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant