Provider Demographics
NPI:1235457789
Name:RICHARDSON, RACHEL REBECCA (DO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:REBECCA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611-0698
Mailing Address - Country:US
Mailing Address - Phone:662-838-2163
Mailing Address - Fax:
Practice Address - Street 1:12 BRUNSWICK ST
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611-7000
Practice Address - Country:US
Practice Address - Phone:662-838-2163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine