Healthcare Provider Details

I. General information

NPI: 1659009777
Provider Name (Legal Business Name): LISA MARIE RICHMOND FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 HARPER RD STE 102
BECKLEY WV
25801-3376
US

IV. Provider business mailing address

349 WHISPERING LN
FAYETTEVILLE WV
25840-6645
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-9211
  • Fax:
Mailing address:
  • Phone: 304-573-6198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number113698
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: