Provider Demographics
NPI:1922848688
Name:MENEFEE, RICHARD WADE III (CRNP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:WADE
Last Name:MENEFEE
Suffix:III
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 WHITFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-2718
Mailing Address - Country:US
Mailing Address - Phone:256-278-0569
Mailing Address - Fax:
Practice Address - Street 1:3479 COUNTY ROAD 94
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35634-4845
Practice Address - Country:US
Practice Address - Phone:256-297-1799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-130743363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care