Provider Demographics
NPI:1386793701
Name:RICHARDSON, LAMANTHA (CFNP)
Entity type:Individual
Prefix:MISS
First Name:LAMANTHA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2332 SCULLING ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3293
Mailing Address - Country:US
Mailing Address - Phone:817-253-8351
Mailing Address - Fax:
Practice Address - Street 1:1547 WARRIOR DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-0921
Practice Address - Country:US
Practice Address - Phone:615-941-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX762390363LF0000X
TN32028363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPKEY-383717421OtherHEALTH NET (TRICARE)
MIPKEY 383717421OtherHEALTH NET (TRICARE)
TXQ76136OtherMEDICARE UPIN