Provider Demographics
NPI:1245369271
Name:WASHINGTON-REDMON, REGENIA (NP)
Entity type:Individual
Prefix:
First Name:REGENIA
Middle Name:
Last Name:WASHINGTON-REDMON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REGENIA
Other - Middle Name:
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 5500
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75712-5500
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:120 E CHARNWOOD ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1708
Practice Address - Country:US
Practice Address - Phone:903-525-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX632686363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9463733OtherTC-PHCS PROVIDER #
TX8J5930Medicare PIN