=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568384816
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INGRID MARIE RICHARDSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2026
-----------------------------------------------------
Last Update Date | 07/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4111 MURRELLS INLET RD
-----------------------------------------------------
City | MURRELLS INLET
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29576-6208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-267-2812
-----------------------------------------------------
Fax | 843-267-2812
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 111 DOCTOR CIR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29203-6502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-267-2812
-----------------------------------------------------
Fax | 843-267-2812
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 32422
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------