Provider Demographics
NPI:1780128025
Name:REDON, JESSICA (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REDON
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 BELMONT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4435
Mailing Address - Country:US
Mailing Address - Phone:508-427-6000
Mailing Address - Fax:508-427-6010
Practice Address - Street 1:1324 BELMONT ST STE 105
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4435
Practice Address - Country:US
Practice Address - Phone:508-427-6000
Practice Address - Fax:508-427-6010
Is Sole Proprietor?:No
Enumeration Date:2016-12-06
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283615363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily