Healthcare Provider Details

I. General information

NPI: 1649994245
Provider Name (Legal Business Name): TRACY LYNETTE RICHARDSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 GLENCROSSING WAY
CINCINNATI OH
45238-3360
US

IV. Provider business mailing address

3183 SUNNYHOLLOW LN
CINCINNATI OH
45239-7152
US

V. Phone/Fax

Practice location:
  • Phone: 513-813-4311
  • Fax:
Mailing address:
  • Phone: 513-462-0222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0032089
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0032089
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: