Provider Demographics
NPI:1013661180
Name:RICHARDSON, NIKEYA BETTS (CRNP)
Entity Type:Individual
Prefix:
First Name:NIKEYA
Middle Name:BETTS
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 BELLEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:REPTON
Mailing Address - State:AL
Mailing Address - Zip Code:36475-3014
Mailing Address - Country:US
Mailing Address - Phone:251-230-1635
Mailing Address - Fax:
Practice Address - Street 1:1815 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4110
Practice Address - Country:US
Practice Address - Phone:251-937-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1121230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily