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General NPI Number Information
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NPI Number | 1063039378
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Entity Type | Individual
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Provider Name | SAMANTHA DION RICHARDSON NP
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Gender | Female
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Dates
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Enumeration Date | 07/02/2020
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 12301 GRAPEFIELD RD
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City | BASTIAN
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State | VA
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Zip | 24314-4547
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Country | US
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Telephone | 276-688-4331
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Fax | 276-688-4336
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Provider Business Mailing Address
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Address Line | 12301 GRAPEFIELD RD
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City | BASTIAN
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State | VA
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Zip | 24314-4547
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Country | US
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Telephone | 276-688-4331
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Fax | 276-688-4336
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.022272
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2021029431
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024178357
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License Number State | VA
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