Healthcare Provider Details

I. General information

NPI: 1124296140
Provider Name (Legal Business Name): MS. BARBARA ANN RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22108 SENNA HLS
GARDEN RIDGE TX
78266-2156
US

IV. Provider business mailing address

22108 SENNA HLS
GARDEN RIDGE TX
78266-2156
US

V. Phone/Fax

Practice location:
  • Phone: 210-437-2667
  • Fax:
Mailing address:
  • Phone: 210-437-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number634972
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: