Healthcare Provider Details

I. General information

NPI: 1790365369
Provider Name (Legal Business Name): YVETTE MICHELE RICHARDSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2021
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 CASTROVILLE RD
SAN ANTONIO TX
78207-5147
US

IV. Provider business mailing address

448 CASTROVILLE RD
SAN ANTONIO TX
78207-5147
US

V. Phone/Fax

Practice location:
  • Phone: 210-434-1400
  • Fax: 210-431-7472
Mailing address:
  • Phone: 210-434-1400
  • Fax: 210-431-7472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1032690
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: