Healthcare Provider Details

I. General information

NPI: 1629547336
Provider Name (Legal Business Name): CIERRA TRANESE RICHARDSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 KENROSS DR
COLUMBUS OH
43207-8766
US

IV. Provider business mailing address

4715 KENROSS DR
COLUMBUS OH
43207-8766
US

V. Phone/Fax

Practice location:
  • Phone: 513-815-1483
  • Fax:
Mailing address:
  • Phone: 513-815-1483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0042247
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: