Healthcare Provider Details

I. General information

NPI: 1013661420
Provider Name (Legal Business Name): DEMETRIA WARD-RICHARDSON MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2022
Last Update Date: 05/01/2022
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 OWEN DR
FAYETTEVILLE NC
28304-3425
US

IV. Provider business mailing address

1601 OWEN DR
FAYETTEVILLE NC
28304-3425
US

V. Phone/Fax

Practice location:
  • Phone: 910-678-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number260698
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: