Provider Demographics
NPI:1679649982
Name:RICHESON, SHAYLENE (RN)
Entity type:Individual
Prefix:
First Name:SHAYLENE
Middle Name:
Last Name:RICHESON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE C648
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6867
Mailing Address - Country:US
Mailing Address - Phone:972-566-2500
Mailing Address - Fax:972-566-6047
Practice Address - Street 1:7777 FOREST LN STE C648
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6867
Practice Address - Country:US
Practice Address - Phone:972-566-2500
Practice Address - Fax:972-566-6047
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX679571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse