Healthcare Provider Details

I. General information

NPI: 1043673965
Provider Name (Legal Business Name): MS. DIONNA RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3408 ANGELIQUE DR
VIOLET LA
70092-2854
US

IV. Provider business mailing address

14307 MOSSY GATE LN
HOUSTON TX
77082-2160
US

V. Phone/Fax

Practice location:
  • Phone: 888-366-6116
  • Fax: 888-366-6116
Mailing address:
  • Phone: 713-429-2767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: