1871597773 NPI number — MISTY RICHARDS APRN

Table of content: MISTY RICHARDS APRN (NPI 1871597773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871597773 NPI number — MISTY RICHARDS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDS
Provider First Name:
MISTY
Provider Middle Name:
Provider Name Prefix Text:
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:
1871597773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 S JEFFERS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH PLATTE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
69101-5349
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-534-6687
Provider Business Mailing Address Fax Number:
308-534-1874

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 S JEFFERS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH PLATTE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69101-5349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-534-6687
Provider Business Practice Location Address Fax Number:
308-534-1874
Provider Enumeration Date:
06/08/2005

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: 363LP2300X , with the licence number:  110278 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 47082269513 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com