Provider Demographics
NPI:1932106994
Name:LEVITT, RICHARD HENRY (FNP)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HENRY
Last Name:LEVITT
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:TX
Mailing Address - Zip Code:79346-4049
Mailing Address - Country:US
Mailing Address - Phone:806-891-5622
Mailing Address - Fax:575-205-0377
Practice Address - Street 1:2021 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4086
Practice Address - Country:US
Practice Address - Phone:575-935-7777
Practice Address - Fax:575-935-7778
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
NMR27256363LF0000X
TX658055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No251B00000XAgenciesCase Management