Richardson, Kelly R

Richardson, Kelly R is an individual health care provider with primary practice located at 914 N Dixie Ave Suite 304, Elizabethtown KY 42701-2520. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Richardson, Kelly R can be contacted via phone (270) 769-1049.

Contact Information

Primary practice address
914 N Dixie Ave Suite 304 Elizabethtown KY 42701-2520
Phone: (270) 769-1049
Fax: (270) 735-1978
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA816 Kentucky

Profile Details

NPI number 1225038086
LBN Legal business name Richardson, Kelly R
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 22nd, 2005
Last updated Jun 2nd, 2015 - about 11 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 1225038086 NPPES
Kentucky MEDICAID 95004131

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