Provider Demographics
NPI: | 1245563725 |
---|---|
Name: | REDMOND, JOSEPHINE WALKER DION (PA-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOSEPHINE WALKER |
Middle Name: | DION |
Last Name: | REDMOND |
Suffix: | |
Gender: | F |
Credentials: | PA-C |
Other - Prefix: | |
Other - First Name: | JOSEPHINE |
Other - Middle Name: | WALKER |
Other - Last Name: | DION |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | |
Mailing Address - Street 1: | 8906 TWO NOTCH RD |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBIA |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29223-6366 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 803-254-3676 |
Mailing Address - Fax: | 803-254-3678 |
Practice Address - Street 1: | 457 SPRUCE ST |
Practice Address - Street 2: | |
Practice Address - City: | WALTERBORO |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29488-2766 |
Practice Address - Country: | US |
Practice Address - Phone: | 843-781-7428 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-09-15 |
Last Update Date: | 2023-10-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 1448 | 363A00000X |
FL | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | 0879PA | Medicaid | |
SC | P00928290 | Other | RR MEDICARE |
SC | P00928290 | Other | RR MEDICARE |
SC | AA44335277 | Medicare PIN |