Provider Demographics
NPI:1881263705
Name:RICHARDSON, JOHN (MSN, APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:MSN, APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9180 PINECROFT DR STE 500
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3883
Mailing Address - Country:US
Mailing Address - Phone:713-897-5900
Mailing Address - Fax:
Practice Address - Street 1:9180 PINECROFT DR STE 500
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3883
Practice Address - Country:US
Practice Address - Phone:713-897-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX915464163WH0200X
TX1045565363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WH0200XNursing Service ProvidersRegistered NurseHome Health