Provider Demographics
NPI:1356638993
Name:REDD, VICKY
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
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 1:9073 HOOPER RD NE
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9025
Mailing Address - Country:US
Mailing Address - Phone:910-200-7682
Mailing Address - Fax:
Practice Address - Street 1:9073 HOOPER RD NE
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9025
Practice Address - Country:US
Practice Address - Phone:910-200-7682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2011-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)