Provider Demographics
NPI:1568653525
Name:RICHARDSON, MISSY LANETT (NP)
Entity type:Individual
Prefix:
First Name:MISSY
Middle Name:LANETT
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP
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 609
Mailing Address - Street 2:
Mailing Address - City:VAN HORN
Mailing Address - State:TX
Mailing Address - Zip Code:79855-0609
Mailing Address - Country:US
Mailing Address - Phone:432-283-2760
Mailing Address - Fax:432-283-8152
Practice Address - Street 1:FM 2185 AND EISENHOWER RD
Practice Address - Street 2:
Practice Address - City:VAN HORN
Practice Address - State:TX
Practice Address - Zip Code:79855
Practice Address - Country:US
Practice Address - Phone:432-283-2760
Practice Address - Fax:432-283-8125
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02441363LF0000X, 363LF0000X
TXAP115962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31129374Medicaid
COCOA109656Medicare PIN
NM365321YMBVMedicare PIN
COCOAAA3655Medicare PIN