Basic Information
| Provider Information | |||||||||
| NPI: | 1609013226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHMOND-STEPHENS | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | DARLENE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24116 | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392254116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6018257280 | ||||||||
| FaxNumber: | 6018257280 | ||||||||
| Practice Location | |||||||||
| Address1: | 226 WHITEOAK AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391536082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6017829919 | ||||||||
| FaxNumber: | 6018258130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 01/13/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F1008041 | AL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 164W00000X | R887063 | MS | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.