Healthcare Provider Details

I. General information

NPI: 1588666994
Provider Name (Legal Business Name): KATHLEEN B RICHARDSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 GUM SPRINGS RD
WINNFIELD LA
71483
US

IV. Provider business mailing address

163 CARMANE RD
NATCHITOCHES LA
71457-7703
US

V. Phone/Fax

Practice location:
  • Phone: 318-628-3971
  • Fax: 318-648-6934
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP03702
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: