Provider Demographics
NPI:1841902533
Name:RICHARDSON, ASHLEY SHANISE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SHANISE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 BARTON ST
Mailing Address - Street 2:
Mailing Address - City:HEARNE
Mailing Address - State:TX
Mailing Address - Zip Code:77859-3009
Mailing Address - Country:US
Mailing Address - Phone:979-279-3451
Mailing Address - Fax:979-280-0276
Practice Address - Street 1:709 BARTON ST
Practice Address - Street 2:
Practice Address - City:HEARNE
Practice Address - State:TX
Practice Address - Zip Code:77859-3009
Practice Address - Country:US
Practice Address - Phone:979-279-3451
Practice Address - Fax:979-280-0276
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily