Provider Demographics
NPI:1619431285
Name:RICHMOND, ASHLEY DAWN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DAWN
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1420
Mailing Address - Country:US
Mailing Address - Phone:936-242-7484
Mailing Address - Fax:
Practice Address - Street 1:713 SW C AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4311
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator