Provider Demographics
NPI:1386733897
Name:RICHARDSON, RACHELLE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6193
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33041-6193
Mailing Address - Country:US
Mailing Address - Phone:305-809-5680
Mailing Address - Fax:
Practice Address - Street 1:3134 NORTHSIDE DR
Practice Address - Street 2:BLD B
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-8004
Practice Address - Country:US
Practice Address - Phone:305-292-6885
Practice Address - Fax:305-293-1561
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH308584163W00000X
OHNP-09100363LF0000X
FLARNP 9304753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002893500Medicaid
OH2425370Medicaid
FLEP045ZOtherMEDICARE