Provider Demographics
NPI:1871597773
Name:RICHARDS, MISTY (APRN)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S JEFFERS ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5349
Mailing Address - Country:US
Mailing Address - Phone:308-534-6687
Mailing Address - Fax:308-534-1874
Practice Address - Street 1:302 S JEFFERS ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5349
Practice Address - Country:US
Practice Address - Phone:308-534-6687
Practice Address - Fax:308-534-1874
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110278363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082269513Medicaid
NE47082269513Medicaid
NEP19781Medicare UPIN