Provider Demographics
NPI:1427768613
Name:RICHARDS, LARRISA LESHAY
Entity type:Individual
Prefix:
First Name:LARRISA
Middle Name:LESHAY
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E GARRISON BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0421
Mailing Address - Country:US
Mailing Address - Phone:704-671-2193
Mailing Address - Fax:
Practice Address - Street 1:128 E GARRISON BLVD STE D
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0421
Practice Address - Country:US
Practice Address - Phone:704-671-2193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty