Provider Demographics
NPI:1205818937
Name:RICHARDSON, TAMMY (CNP)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 WEST FRONT STREET
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-596-6634
Mailing Address - Fax:276-596-6635
Practice Address - Street 1:2949 FRONT ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2010
Practice Address - Country:US
Practice Address - Phone:276-596-6634
Practice Address - Fax:276-596-6635
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q37747Medicare UPIN
006747055Medicare ID - Type Unspecified