MEDICARE: RUNAKO RICHARDSON NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	291371	AZ
2	363L00000X	Nurse Practitioner	AP125465	TX
3	363LA2200X	Adult Health Nurse Practitioner	125465	TX
4	363LG0600X	Gerontology Nurse Practitioner	125465	TX
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP125465	TX

General Provider Information

NPI Number	:	1992124622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUNAKO RICHARDSON NP

Provider Business Mailing Address
First Line	:	3901 AIRPORT FWY STE 230
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-6091
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 E SOUTHERN AVE STE 1018
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-6201
Country	:	US
Telephone Number	:	602-878-7702
Fax Number	:	602-878-7702

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

Provider Enumeration Date	:	04/09/2014
Last Update Date	:	07/27/2023

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