Provider Demographics
NPI:1801952676
Name:RED, MARY F (WHCNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:RED
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8224 PARK LN STE 130
Practice Address - Street 2:VICKERY HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6021
Practice Address - Country:US
Practice Address - Phone:214-266-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX607808363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139460316Medicaid
TX139460315Medicaid
TX139460317Medicaid
TX139460318Medicaid
TX139460321Medicaid
TX139460325Medicaid
TX139460319Medicaid
TX139460320Medicaid
TX139460322Medicaid
TX139460323Medicaid
TX139460324Medicaid