Provider Demographics
NPI:1992561047
Name:CHARLES, YASHICA REDO (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:YASHICA
Middle Name:REDO
Last Name:CHARLES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 WILLOWGLEN DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4639
Mailing Address - Country:US
Mailing Address - Phone:409-543-9426
Mailing Address - Fax:
Practice Address - Street 1:1310 I-10 W SUITE 102 B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:409-543-9426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX919585163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse