Provider Demographics
NPI:1861982936
Name:REDFEARN, KIM MARIE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MARIE
Last Name:REDFEARN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18415 GARNER LN
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3228
Mailing Address - Country:US
Mailing Address - Phone:202-679-1546
Mailing Address - Fax:
Practice Address - Street 1:18415 GARNER LN
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-3228
Practice Address - Country:US
Practice Address - Phone:202-679-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160299363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology