Provider Demographics
NPI:1770675993
Name:RICHARD, ROSALIE E (APRN BC)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:E
Last Name:RICHARD
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70204 EIKE ST
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3056
Mailing Address - Country:US
Mailing Address - Phone:337-643-8424
Mailing Address - Fax:337-643-8407
Practice Address - Street 1:70420 EIKE ST
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3056
Practice Address - Country:US
Practice Address - Phone:337-643-8424
Practice Address - Fax:337-643-8407
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04081363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1143324Medicaid
LA4C373Medicare PIN
P67352Medicare UPIN