Provider Demographics
NPI:1407615057
Name:HERNANDEZ, RICHARD (NP)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:NP
Other - Prefix:MR
Other - First Name:RICH
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-314-9120
Mailing Address - Fax:803-314-9121
Practice Address - Street 1:5143 FOREST DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4918
Practice Address - Country:US
Practice Address - Phone:803-314-9120
Practice Address - Fax:803-314-9121
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily