Provider Demographics
NPI:1417676271
Name:REDMOND, STACY SHANTE (NP-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:SHANTE
Last Name:REDMOND
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 SIERRA CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1807
Mailing Address - Country:US
Mailing Address - Phone:662-889-7528
Mailing Address - Fax:
Practice Address - Street 1:3103 SIERRA CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1807
Practice Address - Country:US
Practice Address - Phone:662-889-7528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903311363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care