Provider Demographics
NPI:1447725833
Name:REDMOND, KIMBERLY TAWAIN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:TAWAIN
Last Name:REDMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4503
Mailing Address - Country:US
Mailing Address - Phone:202-294-8304
Mailing Address - Fax:
Practice Address - Street 1:5201 CONNECTICUT AVE NW APT 210
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1856
Practice Address - Country:US
Practice Address - Phone:202-749-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant