Provider Demographics
NPI:1386342772
Name:RICHARD, JAQUELINE THERESA (APRN, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JAQUELINE
Middle Name:THERESA
Last Name:RICHARD
Suffix:
Gender:F
Credentials:APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24431 GOODWIN DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-3523
Mailing Address - Country:US
Mailing Address - Phone:618-444-5443
Mailing Address - Fax:
Practice Address - Street 1:1331 W GRAND PKWY N STE 230
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2711
Practice Address - Country:US
Practice Address - Phone:281-392-8620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110933363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care