Basic Information
Provider Information
NPI: 1134671159
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REDDING
FirstName: ZAKRI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5219 CITY BANK PKWY STE 35
Address2:  
City: LUBBOCK
State: TX
PostalCode: 794073545
CountryCode: US
TelephoneNumber: 8067610333
FaxNumber: 8067820097
Practice Location
Address1: 5022 AVENUE Q
Address2:  
City: LUBBOCK
State: TX
PostalCode: 79412
CountryCode: US
TelephoneNumber: 8067623597
FaxNumber: 8067628816
Other Information
ProviderEnumerationDate: 10/25/2016
LastUpdateDate: 03/29/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0200XAP132206TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics

No ID Information.


Home