Provider Demographics
NPI:1740664366
Name:RICHMOND, PHILICIA A (NP)
Entity type:Individual
Prefix:
First Name:PHILICIA
Middle Name:A
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PHILICIA
Other - Middle Name:A
Other - Last Name:TEAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:205 N. EAST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1753
Mailing Address - Country:US
Mailing Address - Phone:517-788-4730
Mailing Address - Fax:517-788-4701
Practice Address - Street 1:205 N. EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-788-4730
Practice Address - Fax:517-788-4701
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704270576363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner