Provider Demographics
NPI:1780757823
Name:RICHARDS, CAROLE JOY (CPNP)
Entity type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:JOY
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5018
Mailing Address - Country:US
Mailing Address - Phone:619-477-6162
Mailing Address - Fax:
Practice Address - Street 1:8010 FROST ST
Practice Address - Street 2:SUITE 414
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2778
Practice Address - Country:US
Practice Address - Phone:858-966-7711
Practice Address - Fax:858-966-7712
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10775363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics