Individual
SIMON P REDMON II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
215 BOBBY BEASLEY ST, SEMINARY, MS 39479-5501
(601) 722-4300
(601) 722-9751
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 722-4300
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R784157
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114375
—
MS
01
—
2007587
UHC
MS
01
—
640507572PA
AMERICAN ADMIN GROUP
MS
Enumeration date
08/28/2006
Last updated
07/20/2020
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