Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 689320 | TX |
N | 363LA2100X | Nurse Practitioner - Acute Care | TAP001475 | LA |
NPI | 1033138854 |
---|---|
Provider Name | Jenny E Richardson |
First Address | Houston, TX 77030-2761 |
Second Address | Houston, TX 77030-2761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 19/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033138854 | BLUE CROSS BLUE SHIELD (01) | TX |
281761101 | (05) | TX |