Provider Demographics
NPI:1780086561
Name:RICHARDSON, SCOTT (DNP)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 RAINBOW DR # 6247
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77399-1062
Mailing Address - Country:US
Mailing Address - Phone:225-454-8232
Mailing Address - Fax:
Practice Address - Street 1:39209 HWY 18 W
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346
Practice Address - Country:US
Practice Address - Phone:225-725-2005
Practice Address - Fax:833-307-1859
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN124815163W00000X
LAAP09538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse