Provider Demographics
NPI:1891763025
Name:REDMON, MALINDA ANN (FAMILY NP)
Entity type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:ANN
Last Name:REDMON
Suffix:
Gender:F
Credentials:FAMILY NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 S ALICE AVE
Mailing Address - Street 2:
Mailing Address - City:MONAHANS
Mailing Address - State:TX
Mailing Address - Zip Code:79756-7602
Mailing Address - Country:US
Mailing Address - Phone:432-556-0199
Mailing Address - Fax:432-943-2457
Practice Address - Street 1:405 S MAIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MONAHANS
Practice Address - State:TX
Practice Address - Zip Code:79756-4506
Practice Address - Country:US
Practice Address - Phone:432-943-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX555484363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily