Individual
CASEY R. RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 432-2297
(260) 434-6481
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28229259A
IN
363L00000X
Nurse Practitioner
71012084A
IN
363LF0000X
Family Nurse Practitioner
Primary
71012084A
IN
Other
Enumeration date
11/10/2021
Last updated
01/20/2022
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