Provider Demographics
NPI:1518366863
Name:RICHARDS, LATOYA (PA-C)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 GREENLEAF CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-0620
Mailing Address - Country:US
Mailing Address - Phone:360-402-0141
Mailing Address - Fax:
Practice Address - Street 1:805 W MCDERMOTT DR # 200
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6501
Practice Address - Country:US
Practice Address - Phone:469-495-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical