Provider Demographics
NPI:1548833593
Name:RICHARDS, LETICHA (WHNP-BC)
Entity type:Individual
Prefix:
First Name:LETICHA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-6243
Mailing Address - Country:US
Mailing Address - Phone:409-351-2201
Mailing Address - Fax:
Practice Address - Street 1:755 N 11TH ST STE P4200
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1521
Practice Address - Country:US
Practice Address - Phone:409-899-1499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037179363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health