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General NPI Number Information
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NPI Number | 1649994245
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Entity Type | Individual
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Provider Name | TRACY LYNETTE RICHARDSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 6922 OHIO AVE
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City | CINCINNATI
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State | OH
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Zip | 45236-3506
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Country | US
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Telephone | 513-793-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 3183 SUNNYHOLLOW LN
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City | CINCINNATI
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State | OH
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Zip | 45239-7152
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Country | US
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Telephone | 513-462-0222
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0032089
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 0032089
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License Number State | OH
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