Healthcare Provider Details

I. General information

NPI: 1700432861
Provider Name (Legal Business Name): RICHARD N. BYRD III CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 HARRISBURG PIKE STE 200
LANCASTER PA
17601-2644
US

IV. Provider business mailing address

2106 HARRISBURG PIKE STE 200
LANCASTER PA
17601-2644
US

V. Phone/Fax

Practice location:
  • Phone: 717-393-1771
  • Fax: 717-393-2782
Mailing address:
  • Phone: 717-393-1771
  • Fax: 717-393-2782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP020514
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberSP020514
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN645160
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: