Healthcare Provider Details

I. General information

NPI: 1013330125
Provider Name (Legal Business Name): DEBRA JANE RICHARDSON M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E SAINT LOUIS AVE
WETUMKA OK
74883-4523
US

IV. Provider business mailing address

208 E SAINT LOUIS AVE
WETUMKA OK
74883-4523
US

V. Phone/Fax

Practice location:
  • Phone: 214-499-8814
  • Fax:
Mailing address:
  • Phone: 214-499-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: