Healthcare Provider Details

I. General information

NPI: 1982141446
Provider Name (Legal Business Name): MYRA ANNE RICHARD DNP, APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYRA A JOHNSON

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 4TH ST
BURLINGTON KS
66839-2602
US

IV. Provider business mailing address

801 N 4TH ST
BURLINGTON KS
66839-2602
US

V. Phone/Fax

Practice location:
  • Phone: 620-364-2121
  • Fax: 620-364-2605
Mailing address:
  • Phone: 620-364-2121
  • Fax: 620-364-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-77534
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: