=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134451032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAYNEL RICHIE NP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2010
-----------------------------------------------------
Last Update Date | 02/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8300 W ELDORADO PKWY BAYBROOKE VILLAGE
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-5946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-738-0769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8517 GALLERY WAY
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75070-8401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-738-0769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | GAYNEL RICHIE
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 214-738-0769
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------