Basic Information
Provider Information
NPI: 1871942201
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REDMOND
FirstName: LYNN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5141 VIRGINIA WAY
Address2: SUITE 390
City: BRENTWOOD
State: TN
PostalCode: 370277572
CountryCode: US
TelephoneNumber: 6159881571
FaxNumber: 6159881635
Practice Location
Address1: 284 HIGHWAY 641 N
Address2:  
City: CAMDEN
State: TN
PostalCode: 383201350
CountryCode: US
TelephoneNumber: 7312132446
FaxNumber: 7312132447
Other Information
ProviderEnumerationDate: 06/07/2016
LastUpdateDate: 06/07/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X21279TNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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