Richardson, Stacy Emmanuel
Richardson, Stacy Emmanuel is an individual health care provider with primary practice located at 4802 E Johnson Ave , Jonesboro AR 72401-8413. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Anesthesiology. Allopathic & Osteopathic Physicians / Anesthesiology is his primary health care specialty. Richardson, Stacy Emmanuel can be contacted via phone (870) 936-8000.Contact Information
Primary practice address
4802 E Johnson Ave
Jonesboro AR 72401-8413
Phone: (870) 936-8000
Fax: (870) 936-2228
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | E-6218 | Arkansas |
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | E-6218 | Arkansas |
Profile Details
| NPI number | 1891968293 |
|---|---|
| LBN Legal business name | Richardson, Stacy Emmanuel |
| Credentials | D.O., E.D.D. |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 7th, 2008 |
| Last updated | Oct 18th, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1891968293 | NPPES |
| Arkansas | MEDICAID | 179973003 |
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