Basic Information
| Provider Information | |||||||||
| NPI: | 1285036665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDS | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | LAREE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PONDER | ||||||||
| OtherFirstName: | WHITNEY | ||||||||
| OtherMiddleName: | LAREE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5012 S US HIGHWAY 75 STE 300 | ||||||||
| Address2: | ATT: BILLING | ||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750204589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034166430 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5012 S US HIGHWAY 75 | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | DENISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750204587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034166430 | ||||||||
| FaxNumber: | 9034166431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2014 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP126439 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 200651550A | 05 | OK | MEDICAID | 8280NY | 01 | TX | BCBS OF TX | OTHER | 342423602 | 05 | TX | MEDICAID |