Provider Demographics
NPI:1427071083
Name:RICHARDSON, TERI LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:LYNN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TERI
Other - Middle Name:LYNN
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PARKSIDE PSYCHIATRIC HOSPITAL, INC
Mailing Address - Street 2:1620 E. 12TH ST.
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-5407
Mailing Address - Country:US
Mailing Address - Phone:918-582-2131
Mailing Address - Fax:918-588-8822
Practice Address - Street 1:1620 E 12TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-5407
Practice Address - Country:US
Practice Address - Phone:918-582-2131
Practice Address - Fax:918-588-8822
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA388363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical