Provider Demographics
NPI:1487251450
Name:REDDEN, VICTORIA ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANN
Last Name:REDDEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 888163
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-1215
Mailing Address - Country:US
Mailing Address - Phone:276-325-0678
Mailing Address - Fax:855-858-0464
Practice Address - Street 1:430 MAIN ST W
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3414
Practice Address - Country:US
Practice Address - Phone:304-469-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV89200163W00000X
WV117550363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty