Healthcare Provider Details

I. General information

NPI: 1881052314
Provider Name (Legal Business Name): KARLIN RICHARDSON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2016
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N 5TH ST
MONROE LA
71201-5317
US

IV. Provider business mailing address

1201 N 5TH ST
MONROE LA
71201-5317
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-8129
  • Fax: 318-600-6095
Mailing address:
  • Phone: 318-512-4997
  • Fax: 318-600-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number228990
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN107776
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: