Provider Demographics
NPI:1255359329
Name:STRAIGHT, RICHARD G (FNP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:STRAIGHT
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 1:106 YUCCA AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:CO
Mailing Address - Zip Code:81226-9548
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 W 5TH ST
Practice Address - Street 2:FLORENCE MEDICAL CENTER
Practice Address - City:FLORENCE
Practice Address - State:CO
Practice Address - Zip Code:81226
Practice Address - Country:US
Practice Address - Phone:719-784-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0001035363A00000X
CO108851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPOO244759OtherRRGA
CO802161Medicare PIN
COP95456Medicare UPIN