=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952186207
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTY JOLENE RICHMOND NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2023
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1990 MCCULLOCH BLVD N STE 109A
-----------------------------------------------------
City | LAKE HAVASU CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86403-5749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-208-1481
-----------------------------------------------------
Fax | 928-505-6474
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1990 MCCULLOCH BLVD N STE 109A
-----------------------------------------------------
City | LAKE HAVASU CITY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86403-5749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-208-1481
-----------------------------------------------------
Fax | 928-505-6474
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 237287
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 237287
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------