| Doctor Name: | MR. RICHARD ENOCH TREADWAY |
| NPI Number: | 1013355379 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSN-FNP |
| License Number: | 17703 |
| Business Practice Address: | 119 Boone Ridge Dr Suite 201 Johnson City, TN - 376154998 |
| Business Phone Number: | 4232821480 |
| Business Fax Number: | 4239281353 |
| Mailing Address: | 119 Boone Ridge Dr, Suite 201 JOHNSON CITY |
| State: | TN |
| Postal Code: | 376154998 |
| Phone Number: | 4232821480 |
| Fax Number: | 4239281353 |
| NPI Enumeration Date: | 06/10/2013 |
| NPI Last Update Date: | 08/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 17703 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |