Provider Demographics
NPI:1962506360
Name:RICHARDSON, TYRONDA SHUREE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:TYRONDA
Middle Name:SHUREE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 KINGS RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6030
Mailing Address - Country:US
Mailing Address - Phone:601-992-8752
Mailing Address - Fax:
Practice Address - Street 1:1500 E. WOODROOW WILSON DRIVE
Practice Address - Street 2:GV SONNY MONTGOMERY DEPARTMENT OF VETERAN AFFAIRS
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-364-1425
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily