Provider Demographics
NPI:1467705467
Name:HEDRICK, REDELLA B (FNP)
Entity Type:Individual
Prefix:MRS
First Name:REDELLA
Middle Name:B
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 SCHOOL HOUSE CMNS STE 171
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7510
Mailing Address - Country:US
Mailing Address - Phone:704-436-4078
Mailing Address - Fax:980-495-8943
Practice Address - Street 1:4311 SCHOOL HOUSE CMNS STE 171
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7510
Practice Address - Country:US
Practice Address - Phone:704-436-4078
Practice Address - Fax:980-495-8943
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005830207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023788510Medicaid
NC1467705467Medicaid