Provider Demographics
NPI:1487637484
Name:REDMOND, JANICE CAROL (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:CAROL
Last Name:REDMOND
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:REDMOND
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2116 MEMORIAL CT
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2629
Mailing Address - Country:US
Mailing Address - Phone:423-646-2424
Mailing Address - Fax:
Practice Address - Street 1:2116 MEMORIAL CT
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2629
Practice Address - Country:US
Practice Address - Phone:423-646-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005996367500000X
VA0024164113367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0939Medicaid
SCQ32503Medicare UPIN
SC430059129Medicare PIN
SCQ325033365Medicare PIN