MEDICARE: MS. PORSHA LYNN RICHARDSON NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	306010	NY
2	363LA2200X	Adult Health Nurse Practitioner	83097	OK
3	363LA2200X	Adult Health Nurse Practitioner	RN182800	GA
4	363LW0102X	Women's Health Nurse Practitioner	421072	NY
5	363LA2200X	Adult Health Nurse Practitioner	20472	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	83097	OTHER	OK	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154621423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PORSHA LYNN RICHARDSON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1117 S DOUGLAS BLVD STE B
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5265
Country	:	US
Telephone Number	:	405-208-4573
Fax Number	:	405-429-4083

Provider Business Practice Location Address
First Line	:	1117 S DOUGLAS BLVD STE B
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5265
Country	:	US
Telephone Number	:	405-208-4573
Fax Number	:	405-429-4083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2010
Last Update Date	:	05/01/2026

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