Healthcare Provider Details

I. General information

NPI: 1912948118
Provider Name (Legal Business Name): RHONDA DENESE RICHARDSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 NW EXPRESSWAY SUITE 350
OKLAHOMA CITY OK
73112-4462
US

IV. Provider business mailing address

11613 WESTERN VIEW DR
OKLAHOMA CITY OK
73162-2037
US

V. Phone/Fax

Practice location:
  • Phone: 405-945-4700
  • Fax: 405-945-4270
Mailing address:
  • Phone: 405-728-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1360
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: