| Doctor Name: | MICKI RICHARDSON |
| NPI Number: | 1083931596 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN-CNP |
| License Number: | R81208 |
| Business Practice Address: | 105 N Indian Meridian Rd Pauls Valley, OK - 730759236 |
| Business Phone Number: | 4052079800 |
| Business Fax Number: | |
| Mailing Address: | Po Box 269024, OKLAHOMA CITY |
| State: | OK |
| Postal Code: | 731269024 |
| Phone Number: | 8663240820 |
| Fax Number: | 4057597725 |
| NPI Enumeration Date: | 04/23/2010 |
| NPI Last Update Date: | 03/23/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SF0001X |
| License Number: | R81208 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Family Health |
| Taxonomy Definition: | |