Provider Demographics
NPI:1639691983
Name:REDDIX, KENNETH BERNARD (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:BERNARD
Last Name:REDDIX
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3942
Mailing Address - Country:US
Mailing Address - Phone:210-226-3204
Mailing Address - Fax:210-226-2854
Practice Address - Street 1:2455 NE LOOP 410 STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5650
Practice Address - Country:US
Practice Address - Phone:210-599-6000
Practice Address - Fax:210-657-5586
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily