Healthcare Provider Details

I. General information

NPI: 1427070606
Provider Name (Legal Business Name): JASON D RICHEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MAIN ST
CHARLESTON AR
72933-9254
US

IV. Provider business mailing address

PO BOX 3528
FORT SMITH AR
72913-3528
US

V. Phone/Fax

Practice location:
  • Phone: 479-963-2132
  • Fax: 479-963-2046
Mailing address:
  • Phone: 479-274-2000
  • Fax: 479-274-2194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-1475
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: