Provider Demographics
NPI:1285222752
Name:RICHARDSON, DIANE (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 W 2710 SOUTH CIR STE 202A
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7205
Mailing Address - Country:US
Mailing Address - Phone:435-990-5443
Mailing Address - Fax:480-520-7515
Practice Address - Street 1:169 W 2710 SOUTH CIR STE 202A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7205
Practice Address - Country:US
Practice Address - Phone:435-990-5443
Practice Address - Fax:480-520-7515
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-09
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6599632-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT6599632-8900OtherAPRN CONTROLLED SUBSTANCE
UT6599632-4405OtherAPRN LICENSE