# RED TYDE

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679156004
- **Authorized official:** TIFFANY M REDMOND PA-C (OWNER)
- **Authorized official phone:** (435) 213-3797

## Contact information

- **Practice address:** 196 S 100 W, LOGAN, UT 84321-5233
- **Practice address phone:** (435) 938-1440
- **Practice address fax:** (833) 359-1642
- **Mailing address:** 280 S MAIN ST, BOUNTIFUL, UT 84010-6236
- **Mailing address phone:** (801) 505-0821
- **Mailing address fax:** (801) 505-0803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | Yes |
| 363AM0700X | Medical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 05/03/2021
- **Last updated:** 10/15/2026