Provider Demographics
NPI:1598410011
Name:MYERS, RICHARD L (RN, BSN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:MYERS
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 E LAKE HIGHLANDS DR APT 2106
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-1145
Mailing Address - Country:US
Mailing Address - Phone:214-762-6076
Mailing Address - Fax:
Practice Address - Street 1:11201 E LAKE HIGHLANDS DR APT 2106
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-1145
Practice Address - Country:US
Practice Address - Phone:214-762-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX589596163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse