Provider Demographics
NPI:1982141446
Name:RICHARD, MYRA ANNE (DNP, APRN-C)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:ANNE
Last Name:RICHARD
Suffix:
Gender:F
Credentials:DNP, APRN-C
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:A
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:66839-2602
Mailing Address - Country:US
Mailing Address - Phone:620-364-2121
Mailing Address - Fax:620-364-2605
Practice Address - Street 1:801 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KS
Practice Address - Zip Code:66839-2602
Practice Address - Country:US
Practice Address - Phone:620-364-2121
Practice Address - Fax:620-364-2605
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-23
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily