Healthcare Provider Details

I. General information

NPI: 1396144341
Provider Name (Legal Business Name): TRAVIS D. RICHARDSON, D.O. PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2014
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
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: 870-239-8102
  • Fax: 870-239-8105
Mailing address:
  • Phone: 870-239-8102
  • Fax: 870-239-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberE4201
License Number StateAR

VIII. Authorized Official

Name: DR. TRAVIS D RICHARDSON
Title or Position: DOCTOR OF OSTEOPATHIC MEDICINE
Credential: D.O.
Phone: 870-239-8102