Healthcare Provider Details

I. General information

NPI: 1720991458
Provider Name (Legal Business Name): AMY KATHERINE PATTERSON RICHARDSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HIGHWAY 12 W
KOSCIUSKO MS
39090-3208
US

IV. Provider business mailing address

130 DAUGHTREY HOLBROOK RD
SUMRALL MS
39482-4827
US

V. Phone/Fax

Practice location:
  • Phone: 601-597-8217
  • Fax:
Mailing address:
  • Phone: 601-597-8217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908771
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: