Provider Demographics
NPI:1558421313
Name:RICHARDSON, CATHY ANNETTE
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ANNETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CATHY
Other - Middle Name:ANNETTE
Other - Last Name:DODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, CNS
Mailing Address - Street 1:2600 EAST 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-6106
Mailing Address - Country:US
Mailing Address - Phone:432-263-0394
Mailing Address - Fax:
Practice Address - Street 1:2600 E 24TH ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-6106
Practice Address - Country:US
Practice Address - Phone:432-263-0394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-27863163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical