Healthcare Provider Details

I. General information

NPI: 1770452799
Provider Name (Legal Business Name): CHEYENNE DENISE RICHARDS LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S FLORIDA AVE
LAKELAND FL
33803-2655
US

IV. Provider business mailing address

1923 S FLORIDA AVE
LAKELAND FL
33803-2655
US

V. Phone/Fax

Practice location:
  • Phone: 863-683-4663
  • Fax: 833-449-4193
Mailing address:
  • Phone: 863-683-4663
  • Fax: 833-449-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW503
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: