Healthcare Provider Details

I. General information

NPI: 1508922832
Provider Name (Legal Business Name): DONALD D RICHARDS JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S MAIN ST
CROSSVILLE TN
38555-5048
US

IV. Provider business mailing address

469 E COVE RD
MONTEREY TN
38574-7053
US

V. Phone/Fax

Practice location:
  • Phone: 931-484-9511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number16122
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: