Provider Demographics
NPI:1619405990
Name:REDD, RYAN RAY (FNP)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:RAY
Last Name:REDD
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16415 NORTHCROSS DR STE C
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5001
Mailing Address - Country:US
Mailing Address - Phone:704-775-6029
Mailing Address - Fax:
Practice Address - Street 1:16415 NORTHCROSS DR STE C
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5001
Practice Address - Country:US
Practice Address - Phone:704-775-6029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily