Healthcare Provider Details

I. General information

NPI: 1578811097
Provider Name (Legal Business Name): PAMELA BROUGH RICHARDSON APRN, FNP-C, ENP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S CARSON ST
CARSON CITY NV
89701-5225
US

IV. Provider business mailing address

675 LUCAS DR
CARSON CITY NV
89701-5600
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-8000
  • Fax:
Mailing address:
  • Phone: 432-294-1698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61962
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number828304
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number593564
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: