Individual
MRS. LISA C RICHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
5 MEDICAL PARK DR, SUITE 101, BENTON, AR 72015-3729
(501) 778-3868
Mailing address
5 MEDICAL PARK DR, SUITE 101, BENTON, AR 72015-3729
(501) 778-3868
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
A#77
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114162720
—
AR
01
—
621697738
TAX ID #
AR
Enumeration date
02/21/2006
Last updated
11/03/2011
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