Healthcare Provider Details

I. General information

NPI: 1649647546
Provider Name (Legal Business Name): RICHARD LYFORD AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

7331 ROUND RIDGE PL
CHESTERFIELD VA
23832-7882
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-3911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024172874
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: