Individual
OLIVIA RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 KOONTZ AVE STE 200, CLENDENIN, WV 25045-9581
(304) 548-7272
(888) 987-8014
Mailing address
104 ALEX LN, CHARLESTON, WV 25304-2952
(304) 734-2040
(304) 734-2047
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
110586
WV
390200000X
Student in an Organized Health Care Education/Training Program
Primary
028695
WV
Other
Enumeration date
04/15/2016
Last updated
03/11/2026
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