Provider Demographics
NPI:1528176807
Name:REDMON, SIMON P II (FNP)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:P
Last Name:REDMON
Suffix:II
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-722-4300
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:215 BOBBY BEASLEY ST
Practice Address - Street 2:
Practice Address - City:SEMINARY
Practice Address - State:MS
Practice Address - Zip Code:39479-5501
Practice Address - Country:US
Practice Address - Phone:601-722-4300
Practice Address - Fax:601-722-9751
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR784157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114375Medicaid
MS640507572PAOtherAMERICAN ADMIN GROUP
MS2007587OtherUHC
MS2007587OtherUHC
MS640507572PAOtherAMERICAN ADMIN GROUP
R83640Medicare UPIN