1740566827 NPI number — MRS. TIFFANY THERESE RICHARDS APRN FNP-BC

Table of content: MRS. TIFFANY THERESE RICHARDS APRN FNP-BC (NPI 1740566827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740566827 NPI number — MRS. TIFFANY THERESE RICHARDS APRN FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDS
Provider First Name:
TIFFANY
Provider Middle Name:
THERESE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740566827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SOUTH MAIN STREET P.O. BOX 315
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
NORTH LIBERTY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-656-3919
Provider Business Mailing Address Fax Number:
574-656-3107

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
NORTH LIBERTY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-656-3919
Provider Business Practice Location Address Fax Number:
574-656-3107
Provider Enumeration Date:
11/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  28147328A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 71003700A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000816222 . This is a "BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 201077780 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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