Provider Demographics
NPI:1891796967
Name:RICHARDS, ROBERTA JO (NPC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JO
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:NPC
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:AUSTIN HEART PLLC
Mailing Address - Street 2:PO BOX 402669
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2669
Mailing Address - Country:US
Mailing Address - Phone:512-206-4300
Mailing Address - Fax:512-206-4350
Practice Address - Street 1:3801 N LAMAR BLVD
Practice Address - Street 2:STE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4080
Practice Address - Country:US
Practice Address - Phone:512-206-3600
Practice Address - Fax:512-454-2581
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX453393207RC0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1637787-01Medicaid
TX1637787-01Medicaid
TX84P300Medicare PIN