Provider Demographics
NPI:1699473975
Name:DANIEL, DANIELLE RICHARDSON (PA-C)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RICHARDSON
Last Name:DANIEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8304 CAHABA CROSSING CIR
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-7901
Mailing Address - Country:US
Mailing Address - Phone:205-283-9841
Mailing Address - Fax:
Practice Address - Street 1:2343 2ND AVE E
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121-2756
Practice Address - Country:US
Practice Address - Phone:205-625-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant