Provider Demographics
NPI:1285051367
Name:COWAN-RICHARDSON, NAKIESHA
Entity type:Individual
Prefix:
First Name:NAKIESHA
Middle Name:
Last Name:COWAN-RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 OLD MADISON PIKE NW
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-2368
Mailing Address - Country:US
Mailing Address - Phone:256-924-7684
Mailing Address - Fax:256-333-4628
Practice Address - Street 1:7027 OLD MADISON PIKE NW
Practice Address - Street 2:SUITE 108
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2368
Practice Address - Country:US
Practice Address - Phone:256-924-7684
Practice Address - Fax:256-333-4628
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1885103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000026Medicaid
AL51169381OtherBLUE CROSS BLUE SHIELD OF ALABAMA