Provider Demographics
NPI:1346296563
Name:RICHARDSON, CLARRISSA E (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:CLARRISSA
Middle Name:E
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-8940
Mailing Address - Country:US
Mailing Address - Phone:901-949-0477
Mailing Address - Fax:901-273-2351
Practice Address - Street 1:1335 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8940
Practice Address - Country:US
Practice Address - Phone:901-949-0477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000115270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily