MEDICARE: MARISSA ANN RICHARDSON APRN

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	363LF0000X	Family Nurse Practitioner	122226	AR

General Provider Information

NPI Number	:	1588521470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA ANN RICHARDSON APRN

Provider Business Mailing Address
First Line	:	771 COUNTY ROAD 759
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72405-7729
Country	:	US
Telephone Number	:	870-615-9186
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 LINWOOD DR STE A
Second Line	:
City	:	PARAGOULD
State	:	AR
Zip	:	72450-5818
Country	:	US
Telephone Number	:	870-239-8105
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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