MEDICARE: RICHARD DAVID RICHARDSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN078427	LA

General Provider Information

NPI Number	:	1013073246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD DAVID RICHARDSON RN

Provider Business Mailing Address
First Line	:	7660 GRIMM RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71107-3444
Country	:	US
Telephone Number	:	318-309-8833
Fax Number	:

Provider Business Practice Location Address
First Line	:	3020 KNIGHT ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71105-2554
Country	:	US
Telephone Number	:	318-862-9899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	07/08/2007

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