Provider Demographics
NPI:1912342825
Name:RICHARDS, CAMILLE YVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:YVONNE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-812-7215
Mailing Address - Fax:501-812-7207
Practice Address - Street 1:923 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4943
Practice Address - Country:US
Practice Address - Phone:479-709-7350
Practice Address - Fax:479-709-7355
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2023-01-30
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-04-03
Provider Licenses
StateLicense IDTaxonomies
NY296570208600000X
ARE-12542208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05385355Medicaid
AR236803001Medicaid