Healthcare Provider Details

I. General information

NPI: 1013881762
Provider Name (Legal Business Name): ANDREA RICHARDSON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GREEN VALLEY RD
CAMERON WV
26033-1161
US

IV. Provider business mailing address

601 GREEN VALLEY RD
CAMERON WV
26033-1161
US

V. Phone/Fax

Practice location:
  • Phone: 813-808-6962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number123990
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: