Provider Demographics
NPI:1912948118
Name:RICHARDSON, RHONDA DENESE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:DENESE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11613 WESTERN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2037
Mailing Address - Country:US
Mailing Address - Phone:405-728-1104
Mailing Address - Fax:
Practice Address - Street 1:3366 NW EXPRESSWAY
Practice Address - Street 2:SUITE 350
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4462
Practice Address - Country:US
Practice Address - Phone:405-945-4700
Practice Address - Fax:405-945-4270
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1360363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical