1285036665 NPI number — MRS. WHITNEY LAREE RICHARDS FNP-C

Table of content: DR. MICHAEL DANIEL PAULA DPM (NPI 1093202699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285036665 NPI number — MRS. WHITNEY LAREE RICHARDS FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDS
Provider First Name:
WHITNEY
Provider Middle Name:
LAREE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PONDER
Provider Other First Name:
WHITNEY
Provider Other Middle Name:
LAREE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285036665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5012 S US HIGHWAY 75 STE 300
Provider Second Line Business Mailing Address:
ATT: BILLING
Provider Business Mailing Address City Name:
DENISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75020-4589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-416-6430
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5012 S US HIGHWAY 75
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
DENISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75020-4587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-416-6430
Provider Business Practice Location Address Fax Number:
903-416-6431
Provider Enumeration Date:
09/17/2014

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: 363LF0000X , with the licence number:  AP126439 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200651550A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8280NY . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 342423602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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