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
Fax: (870) 936-2228
Website:

Health care specialties

SpecialtyCodeLicense #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 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891968293 NPPES
Arkansas MEDICAID 179973003

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