Provider Demographics
NPI:1891791794
Name:REDD, SYLVIA FARRISH (FNP)
Entity Type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:FARRISH
Last Name:REDD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-2258
Mailing Address - Country:US
Mailing Address - Phone:601-638-3123
Mailing Address - Fax:601-638-9353
Practice Address - Street 1:900 WYCHE ST
Practice Address - Street 2:
Practice Address - City:TALLULAH
Practice Address - State:LA
Practice Address - Zip Code:71282-2018
Practice Address - Country:US
Practice Address - Phone:318-574-5371
Practice Address - Fax:318-574-5345
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN059280 APO2557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1101486Medicaid