Sandra Delvalle Richardson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA200735 Issued in LA

Practice address

1541 Kings Hwy
Shreveport, LA 71103-4228

Phone

(318) 626-0000

Fax

(318) 629-4833

NPI assigned

Oct 20, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX, LA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

WK Urgent Care Center-PierremontGroup PAC ID 8123016946, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sandra.richardson.p1@direct.collom-carney.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• WK Urgent Care Center-Pierremont

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1639115132
  Medicare reassignment Care Compare group
• University Health Shreveport LLC

  • Nurse Practitioner
  • Shreveport, LA
  • NPI 1619443611

  Physician Assistant

  Medicare reassignment NPD
• Lsu Health Sciences Center Shreveport Faculty Group Practice

  • Family Medicine Physician
  • Shreveport, LA
  • NPI 1013374222
  Medicare reassignment
• Chris Burling, M.D., P.a.

  • Family Medicine Physician
  • Mt Pleasant, TX
  • NPI 1417990144
  Medicare reassignment
• University Health Shreveport LLC

  • Certified Registered Nurse Anesthetist
  • Shreveport, LA
  • NPI 1629544622
  NPD
• Collom & Carney Clinic Association

  • Cardiovascular Disease Physician
  • Texarkana, TX
  • NPI 1013252279
  NPD
• Collom & Carney Clinic Association

  • Clinical Medical Laboratory
  • Texarkana, TX
  • NPI 1164405296
  NPD
• Collom & Carney Clinic Association

  • Pain Medicine (Anesthesiology) Physician
  • Texarkana, TX
  • NPI 1962829747
  NPD
• WK Urgent Care Center - Bossier

  • Family Medicine Physician
  • Bossier City, LA
  • NPI 1982640884
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1417351446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1666 E BERT KOUNS INDUSTRIAL LOOP",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711055714",
            "telephone_number": "318-212-3520",
            "fax_number": "318-212-3525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1541 KINGS HWY",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034228",
            "telephone_number": "318-626-0000",
            "fax_number": "318-629-4833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2014 Galleria Oaks Dr",
            "address_purpose": "LOCATION",
            "city": "Texarkana",
            "state": "TX",
            "postal_code": "755034620",
            "country_code": "US",
            "telephone_number": "903-614-3609",
            "fax_number": "903-792-2996",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1666 E Bert Kouns Industrial Loop",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711055714",
            "country_code": "US",
            "telephone_number": "318-212-3520",
            "fax_number": "318-212-3525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "SANDRA",
        "middle_name": "DELVALLE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-20",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA09380",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA200735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dennis Ray Richardson
• Jordan McKenzie Richardson
• Kathryn Arlene Richardson, M.D.
• Patricia L Richardson, CNNP
• Richard David Richardson, RN
• Tracy Richardson
• Charles M Richart, MD
• John McIntire Richey, MD
• Maradyth Richey
• John N. Richie, MD

• Physician Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physician Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.