Healthcare Provider Details

I. General information

NPI: 1780086561
Provider Name (Legal Business Name): SCOTT RICHARDSON DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 06/28/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39209 HWY 18 W
DONALDSONVILLE LA
70346
US

IV. Provider business mailing address

162 RAINBOW DR # 6247
LIVINGSTON TX
77399-1062
US

V. Phone/Fax

Practice location:
  • Phone: 225-725-2005
  • Fax: 833-307-1859
Mailing address:
  • Phone: 225-454-8232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP09538
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN124815
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: