Provider Demographics
NPI:1609013226
Name:RICHMOND-STEPHENS, CAROL DARLENE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:DARLENE
Last Name:RICHMOND-STEPHENS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24116
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-4116
Mailing Address - Country:US
Mailing Address - Phone:601-825-7280
Mailing Address - Fax:601-825-7280
Practice Address - Street 1:226 WHITEOAK AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:MS
Practice Address - Zip Code:39153-6082
Practice Address - Country:US
Practice Address - Phone:601-782-9919
Practice Address - Fax:601-825-8130
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALF1008041363LF0000X
MSR887063164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily