Healthcare Provider Details

I. General information

NPI: 1528160512
Provider Name (Legal Business Name): SANDRA E RICHARDSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 SE CENTER RD
BAXTER SPRINGS KS
66713-3184
US

IV. Provider business mailing address

7171 SE CENTER RD
BAXTER SPRINGS KS
66713-3184
US

V. Phone/Fax

Practice location:
  • Phone: 417-434-4777
  • Fax:
Mailing address:
  • Phone: 417-434-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44345
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: