Healthcare Provider Details

I. General information

NPI: 1376031070
Provider Name (Legal Business Name): DEANA CAROL RICHARDS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 6TH AVE
HUNTINGTON WV
25701-2312
US

IV. Provider business mailing address

70 PINE HILL DR
POCA WV
25159-7554
US

V. Phone/Fax

Practice location:
  • Phone: 304-526-9111
  • Fax:
Mailing address:
  • Phone: 304-542-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number50674
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: