Healthcare Provider Details

I. General information

NPI: 1891968293
Provider Name (Legal Business Name): STACY EMMANUEL RICHARDSON D.O., E.D.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2008
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: 870-239-8105
  • 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 NumberE-6218
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-6218
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: