Healthcare Provider Details

I. General information

NPI: 1326385840
Provider Name (Legal Business Name): SUMMER BROOKE RICHARDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2013
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 QUINCY ST
PLAINVIEW TX
79072-4206
US

IV. Provider business mailing address

1806 QUINCY ST
PLAINVIEW TX
79072-4206
US

V. Phone/Fax

Practice location:
  • Phone: 806-288-7891
  • Fax: 806-288-7922
Mailing address:
  • Phone: 806-288-7891
  • Fax: 806-288-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA08014
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: