Healthcare Provider Details

I. General information

NPI: 1346296563
Provider Name (Legal Business Name): CLARRISSA E RICHARDSON MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 WINFIELD RD
MEMPHIS TN
38116-8940
US

IV. Provider business mailing address

1335 WINFIELD RD
MEMPHIS TN
38116-8940
US

V. Phone/Fax

Practice location:
  • Phone: 901-949-0477
  • Fax:
Mailing address:
  • Phone: 901-949-0477
  • Fax: 901-273-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN0000115270
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: