Healthcare Provider Details

I. General information

NPI: 1609384056
Provider Name (Legal Business Name): MATTHEW RICHARDSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 MAIN ST
ZACHARY LA
70791-4037
US

IV. Provider business mailing address

23155 GREENWELL SPRINGS RD
GREENWELL SPRINGS LA
70739-6015
US

V. Phone/Fax

Practice location:
  • Phone: 225-658-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number216950
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: