Provider Demographics
NPI:1003000837
Name:JOHN, RICHARD L JR (APRN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:JOHN
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:L
Other - Last Name:JOHN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:1550 E. MAIN ST
Mailing Address - Street 2:MENTAL HEALTH
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93254
Mailing Address - Country:US
Mailing Address - Phone:805-354-6053
Mailing Address - Fax:
Practice Address - Street 1:1550 E MAIN ST
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4819
Practice Address - Country:US
Practice Address - Phone:805-354-6053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 13309363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily