Individual
JENNY E RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
700 E MARSHALL AVE, LONGVIEW, TX 75601-5580
(903) 315-1488
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 606-6400
(903) 606-1522
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP120167
TX
363LA2100X
Acute Care Nurse Practitioner
Primary
689320
TX
363LA2100X
Acute Care Nurse Practitioner
AP120167
TX
363LA2100X
Acute Care Nurse Practitioner
TAP001475
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033138854
BLUE CROSS BLUE SHIELD
TX
05
—
281761101
—
TX
Enumeration date
07/19/2006
Last updated
10/05/2023
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