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NPI Code Detail

MEDICARE: MRS. CONNIE B RICHARDSON C.F.N.P.

MEDICARE: MRS. CONNIE B RICHARDSON C.F.N.P.
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
1363LS0200XSchool Nurse PractitionerR702226MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2640654841OTHERMSTRICARE FOR LIFE

General Provider Information

NPI Number : 1629136221
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CONNIE B RICHARDSON C.F.N.P.
Provider Business Mailing Address
First Line : 117 BEACH PARK PL
Second Line :
City : LONG BEACH
State : MS
Zip : 39560-6223
Country : US
Telephone Number : 228-214-3300
Fax Number : 228-214-3344
Provider Business Practice Location Address
First Line : 180B DEBUYS RD
Second Line : SUITE 223
City : BILOXI
State : MS
Zip : 39531-4404
Country : US
Telephone Number : 228-388-4862
Fax Number : 228-388-2556
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 03/17/2025

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