Provider Demographics
NPI:1487112066
Name:RICHIE, FREDA CATHERINE (RN)
Entity type:Individual
Prefix:
First Name:FREDA
Middle Name:CATHERINE
Last Name:RICHIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643
Mailing Address - Country:US
Mailing Address - Phone:254-300-2359
Mailing Address - Fax:254-300-5761
Practice Address - Street 1:211 BUCKINGHAM PL
Practice Address - Street 2:
Practice Address - City:HEWITT
Practice Address - State:TX
Practice Address - Zip Code:76643
Practice Address - Country:US
Practice Address - Phone:254-300-2359
Practice Address - Fax:254-300-5761
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX720969163W00000X
172A00000X, 347C00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No163W00000XNursing Service ProvidersRegistered Nurse
No172A00000XOther Service ProvidersDriver
No347C00000XTransportation ServicesPrivate Vehicle