Mary D Redfearn

Primary specialty

Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X

License

ARNP485802 Issued in FL

Practice address

3229 Bear Run Blvd BLDG B
Orange Park, FL 32065-7334

Phone

(904) 272-3177

NPI assigned

Nov 17, 2006

Last updated

Dec 21, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Florida Department of Health

  • Public Health or Welfare Agency
  • Fleming Island, FL
  • NPI 1780759175
  NPD (past)

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1356048000000",
    "number": "1215001896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 578",
            "city": "GREEN COVE SPRINGS",
            "state": "FL",
            "postal_code": "320430578",
            "telephone_number": "904-272-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3229 BEAR RUN BLVD BLDG B",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320657334",
            "telephone_number": "904-272-3177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDFEARN",
        "first_name": "MARY",
        "middle_name": "D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-17",
        "last_updated": "2012-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP485802",
            "primary": false
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "FL",
            "license": "ARNP485802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "034577600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• RCCN Pain Management LLC
• Read Reflect & Repair Health and Wellness
• Rebound Rehabilitative Services Inc
• Rama T Reddy, MD
• Redefined Birthing Doula Services
• Andrea Winsor Redlitz
• Douglas Mark Reed, D.D.S.
• Keven Charles Reed, O.D.
• Maria Reed, MSN, PMHNP-BC
• Angela N Reemelin, RD

• Obstetrics & Gynecology Nurse Practitioner in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Obstetrics & Gynecology Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2012; 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.