Provider Demographics
NPI:1700892346
Name:RICHARD, JOSEPH H (CFNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:H
Last Name:RICHARD
Suffix:
Gender:M
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:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-249-4710
Mailing Address - Fax:601-249-4716
Practice Address - Street 1:300 RAWLS DR
Practice Address - Street 2:STE 1200
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2877
Practice Address - Country:US
Practice Address - Phone:601-249-4710
Practice Address - Fax:601-249-4716
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR704547363L00000X
MS704547363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01772838Medicaid
MS100000190Medicare PIN
MS01772838Medicaid
MS390982YQVYMedicare PIN