Provider Demographics
NPI:1033934203
Name:RICHMOND, JESSICA MONIQUE
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MONIQUE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST MAIN
Mailing Address - Street 2:B
Mailing Address - City:HAYTI
Mailing Address - State:MO
Mailing Address - Zip Code:63851
Mailing Address - Country:US
Mailing Address - Phone:573-931-4821
Mailing Address - Fax:
Practice Address - Street 1:1201 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-5445
Practice Address - Country:US
Practice Address - Phone:870-763-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist