1780141093 NPI number — MRS. SHERRIE B RICHARDSON APRN

Table of content: MRS. SHERRIE B RICHARDSON APRN (NPI 1780141093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780141093 NPI number — MRS. SHERRIE B RICHARDSON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON
Provider First Name:
SHERRIE
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1780141093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC CLELLANVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29458-0608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-990-7971
Provider Business Mailing Address Fax Number:
843-887-3817

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 N MORGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDREWS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29510-2417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-264-2680
Provider Business Practice Location Address Fax Number:
843-264-2690
Provider Enumeration Date:
02/22/2019

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:  22558 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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