MEDICARE: KEVIN RICHARDSON AA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367H00000X	Anesthesiologist Assistant
2	367H00000X	Anesthesiologist Assistant	1687	TX

General Provider Information

NPI Number	:	1538577200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN RICHARDSON AA-C

Provider Business Mailing Address
First Line	:	PO BOX 4439
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4439
Country	:	US
Telephone Number	:	713-792-2991
Fax Number	:

Provider Business Practice Location Address
First Line	:	6720 BERTNER AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2604
Country	:	US
Telephone Number	:	832-355-2666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2014
Last Update Date	:	04/08/2026

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