Basic Information
| Provider Information | |||||||||
| NPI: | 1619545795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | FAYE | ||||||||
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| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11051 COUNTY ROAD 3470 | ||||||||
| Address2: | |||||||||
| City: | STRATFORD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748725251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802352546 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 610 E 24TH ST | ||||||||
| Address2: | |||||||||
| City: | TISHOMINGO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 734603245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803712343 | ||||||||
| FaxNumber: | 5803713614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2021 | ||||||||
| LastUpdateDate: | 09/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 204266 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.