Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 219779 | NC |
NPI | 1013212158 |
---|---|
Provider Name | Felicia R. Richardson |
First Address | Charlotte, NC 28275-1069 |
Second Address | Greenville, NC 27834-3773 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2011 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
189QL | BCBS NC (01) | NC |
7004728 | (05) | NC |
P00963712 | RAILROAD MEDICARE PROV # (01) | NC |