Healthcare Provider Details

I. General information

NPI: 1629136221
Provider Name (Legal Business Name): CONNIE B RICHARDSON C.F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180B DEBUYS RD SUITE 223
BILOXI MS
39531-4404
US

IV. Provider business mailing address

117 BEACH PARK PL
LONG BEACH MS
39560-6223
US

V. Phone/Fax

Practice location:
  • Phone: 228-388-4862
  • Fax: 228-388-2556
Mailing address:
  • Phone: 228-214-3300
  • Fax: 228-214-3344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberR702226
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: