Provider Demographics
NPI:1316721988
Name:REDDING, KAMRON RAYMONE
Entity type:Individual
Prefix:
First Name:KAMRON
Middle Name:RAYMONE
Last Name:REDDING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 ASHLEY RIVER RD APT 297
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-4732
Mailing Address - Country:US
Mailing Address - Phone:240-997-2097
Mailing Address - Fax:
Practice Address - Street 1:151B RUTLEDGE AVE # MSC962
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-4732
Practice Address - Country:US
Practice Address - Phone:240-997-2097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1036534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse