Provider Demographics
NPI:1033923396
Name:REDDICK-JESSIE, STEPHANIE-LOUISE (RN)
Entity type:Individual
Prefix:
First Name:STEPHANIE-LOUISE
Middle Name:
Last Name:REDDICK-JESSIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STEPHANIE-LOUISE
Other - Middle Name:
Other - Last Name:REDDICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5782 FIRETHORN DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75249-2310
Mailing Address - Country:US
Mailing Address - Phone:972-765-8255
Mailing Address - Fax:
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:800-849-3597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX823938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse