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NPI Code Detail

MEDICARE: DEMETRIA ATHENA RICHARDS APRN

MEDICARE: DEMETRIA ATHENA RICHARDS 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
1363LF0000XFamily Nurse Practitioner31617TN

General Provider Information

NPI Number : 1952032294
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEMETRIA ATHENA RICHARDS APRN
Provider Business Mailing Address
First Line : 1150 HAWKINS CRAWFORD RD
Second Line :
City : COOKEVILLE
State : TN
Zip : 38501-6661
Country : US
Telephone Number : 931-510-3759
Fax Number :
Provider Business Practice Location Address
First Line : 702 S CUMBERLAND ST
Second Line :
City : LEBANON
State : TN
Zip : 37087-4110
Country : US
Telephone Number : 615-444-2121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2022
Last Update Date : 02/21/2024

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