MEDICARE: STEPHANIE YALANDA RICHEY

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1629498720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE YALANDA RICHEY

Provider Business Mailing Address
First Line	:	3132 BRICKDALE LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2404
Country	:	US
Telephone Number	:	615-969-7113
Fax Number	:

Provider Business Practice Location Address
First Line	:	3132 BRICKDALE LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2404
Country	:	US
Telephone Number	:	615-969-7113
Fax Number	:

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

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	04/16/2014

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