Provider Demographics
NPI:1063011682
Name:REDD, TIFFANY DENICE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DENICE
Last Name:REDD
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 1:15092 S JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:MS
Mailing Address - Zip Code:39063-3900
Mailing Address - Country:US
Mailing Address - Phone:662-571-8362
Mailing Address - Fax:
Practice Address - Street 1:15092 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:MS
Practice Address - Zip Code:39063-3900
Practice Address - Country:US
Practice Address - Phone:662-571-8362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker