Healthcare Provider Details

I. General information

NPI: 1265087092
Provider Name (Legal Business Name): RICHARDSON ANESTHESIA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 LINWOOD DR STE A
PARAGOULD AR
72450-5818
US

IV. Provider business mailing address

1507 LINWOOD DR STE A
PARAGOULD AR
72450-5818
US

V. Phone/Fax

Practice location:
  • Phone: 870-615-2091
  • Fax: 870-641-2042
Mailing address:
  • Phone: 870-239-8105
  • Fax: 870-641-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STACY EMMANUEL RICHARDSON
Title or Position: PRESIDENT
Credential: DO
Phone: 870-615-2091