Provider Demographics
NPI:1124419676
Name:REDING, JESSICA (RPH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REDING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 230TH ST
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66052-4120
Mailing Address - Country:US
Mailing Address - Phone:785-218-4719
Mailing Address - Fax:
Practice Address - Street 1:11325 230TH ST
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:KS
Practice Address - Zip Code:66052-4120
Practice Address - Country:US
Practice Address - Phone:785-218-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS113677305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service