MEDICARE: MS. CATHY ANNETTE RICHARDSON

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	163WM0705X	Medical-Surgical Registered Nurse	2-27863	TX

General Provider Information

NPI Number	:	1558421313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHY ANNETTE RICHARDSON

Provider Business Mailing Address
First Line	:	2600 EAST 24TH STREET
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-6106
Country	:	US
Telephone Number	:	432-263-0394
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 E 24TH ST
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-6106
Country	:	US
Telephone Number	:	432-263-0394
Fax Number	:

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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