Provider Demographics
NPI:1053618710
Name:COMER, RICHARD (FNP-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:COMER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:BALDWYN
Mailing Address - State:MS
Mailing Address - Zip Code:38824-2114
Mailing Address - Country:US
Mailing Address - Phone:662-620-1496
Mailing Address - Fax:
Practice Address - Street 1:529 S FOURTH ST
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824-2114
Practice Address - Country:US
Practice Address - Phone:662-620-1496
Practice Address - Fax:662-365-2255
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily