Raynette Fredericks, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN5173031 Issued in FL

Practice address

1520 NE Riddell Rd # 110
Bremerton, WA 98310-3005

Phone

(786) 518-8971

NPI assigned

Oct 29, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1194547208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1970 NE FUSON RD APT 204",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983113739",
            "telephone_number": "786-518-8971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 NE RIDDELL RD # 110",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983103005",
            "telephone_number": "786-518-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREDERICKS",
        "first_name": "RAYNETTE",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-29",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "FL",
            "license": "PN5173031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fred Meyer Stores Inc
• Paul Jared Fredenberg, PHARMD
• Frederick D Leist MD Inc PS
• Daniel Earl Frederick, M.D.
• Lori Fredericks, LMP
• Samuel Freeman
• Lisa Freeze
• Lisa Frerichs, PTA
• Robert Kevin Frerichs
• Kaitlyn Frey, DMD

• Licensed Practical Nurse in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Licensed Practical Nurse in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.