Provider Demographics
NPI:1326454216
Name:RICHARDS, NICOLE N
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:N
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:N
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, FNP-C
Mailing Address - Street 1:3012 SAN EFRAIN
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-7675
Mailing Address - Country:US
Mailing Address - Phone:956-343-7001
Mailing Address - Fax:
Practice Address - Street 1:3012 SAN EFRAIN
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-7675
Practice Address - Country:US
Practice Address - Phone:956-343-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX659183/AP125786363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily