SHUNDRICKA ROCHELLE REDDICK (NPI# 1407301724) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407301724 |
| Entity Type | Individual |
| Full Name | SHUNDRICKA ROCHELLE REDDICK |
| Credential | NURSE PRACTITIONER |
| Practice Address |
407 S Gould Ave Gould AR 71643-5041 |
| Mailing Address |
4201 Skyline Dr Pine Bluff AR 71603-7743 |
| Practice Telephone | 8702634317 |
| Practice Fax Number | 8702634782 |
| Mailing Telephone | 8706927336 |
| Enumeration Date | 2016-08-16 |
| Last Update Date | 2019-12-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
A004877 | AR | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 4201 S Mulberry St, Pine Bluff, AR 716037016 | 8705418660 |
| Street Address |
407 S GOULD AVE |
| City | GOULD |
| State | AR |
| Zip Code | 71643-5041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861593410 | Charles J Woodyard | Dentist | 407 S Gould Ave, Gould, AR 71643-5041 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023540655 | Aaron M Smith | General Practice | Varner Unit State Hwy 388, Gould, AR 71643 | 2017-04-02 |
| 1689890063 | Ascension Depaul Services | Dentist | 407 South Gould Ave, Gould, AR 71643 | 2007-04-17 |
| 1033368246 | Robert Brice Scott | Family Medicine | 407 South Gould Ave., Gould, AR 71643-0000 | 2008-09-11 |
| 1689775231 | Ascension Depaul Services | Clinic/Center | 407 South Gould Ave, Gould, AR 71643-0370 | 2006-09-26 |
| 1679012504 | Lerizza D Nunag | Nurse Practitioner | 2540 State Highway 388, Gould, AR 71643-9634 | 2017-02-13 |
| 1699245985 | Rose Marie Newby | Nurse Practitioner | 2540 State Highway 388, Gould, AR 71643-9634 | 2018-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023540655 | Aaron M Smith | General Practice | Varner Unit State Hwy 388, Gould, AR 71643 | 2017-04-02 |
| 1679012504 | Lerizza D Nunag | Nurse Practitioner | 2540 State Highway 388, Gould, AR 71643-9634 | 2017-02-13 |
| 1033368246 | Robert Brice Scott | Family Medicine | 407 South Gould Ave., Gould, AR 71643-0000 | 2008-09-11 |
| 1689775231 | Ascension Depaul Services | Clinic/Center | 407 South Gould Ave, Gould, AR 71643-0370 | 2006-09-26 |
| 1699245985 | Rose Marie Newby | Nurse Practitioner | 2540 State Highway 388, Gould, AR 71643-9634 | 2018-11-29 |
| 1689890063 | Ascension Depaul Services | Dentist | 407 South Gould Ave, Gould, AR 71643 | 2007-04-17 |
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245985 | Rose Marie Newby | Nurse Practitioner | 2540 State Highway 388, Gould, AR 71643-9634 | 2018-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023617594 | Mckenzie Lauren Cotton | Nurse Practitioner | 1065 Skyline Dr, Conway, AR 72032-3530 | 2020-10-25 |
| 1437758026 | Ashley Michelle Rima | Nurse Practitioner | 205 Spencer St, Hot Springs, AR 71901-7742 | 2020-10-23 |
| 1063010874 | Phillip Wayne Stokes Jr. | Nurse Practitioner | 31 Ashcraft Ct, Paragould, AR 72450-7592 | 2020-10-14 |
| 1720685308 | Dannie Evenda Loy | Nurse Practitioner | 101 Hammond Drive #2131, Hot Springs, AR 71914 | 2020-10-06 |
| 1457958233 | Kaitlyn Soffray Simmons | Nurse Practitioner | 500 Kitchen St, Jonesboro, AR 72401-3135 | 2020-10-05 |
| 1013524487 | Danielle Lynn Frueh | Nurse Practitioner | 103 W University St, Siloam Springs, AR 72761-2663 | 2020-09-29 |
| 1407463938 | Aleshia Williams | Nurse Practitioner | 5401 Clear Creek Ln, Jonesboro, AR 72404-7006 | 2020-09-29 |
| 1801403217 | Jessica Evelyn Mcnamee | Nurse Practitioner | 180 Medical Park Pl Ste 202, Hot Springs, AR 71901-8067 | 2020-09-29 |
| 1437765831 | Allison Nicole Hitt | Nurse Practitioner | 3644 W Hwy 18, Manila, AR 72442 | 2020-09-21 |
| 1528674181 | Maggie Mullican | Nurse Practitioner | 7084 S Pleasant Ridge Dr, Fayetteville, AR 72704-5447 | 2020-09-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.