Provider Demographics
NPI:1205124849
Name:REDMAN, MARY (PNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:REDMAN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 S WOODS MILL RD
Mailing Address - Street 2:STE 36W
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3662
Mailing Address - Country:US
Mailing Address - Phone:314-453-9666
Mailing Address - Fax:314-453-9895
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:STE 36W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-453-9666
Practice Address - Fax:314-453-9895
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO062410106H00000X, 363LP0200X
MOM0062410363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420038232Medicaid