Healthcare Provider Details

I. General information

NPI: 1922611748
Provider Name (Legal Business Name): CAITLIN RICHARDSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 16TH ST
GREELEY CO
80631-5199
US

IV. Provider business mailing address

4637 CHABOT DR STE 104
PLEASANTON CA
94588-2749
US

V. Phone/Fax

Practice location:
  • Phone: 970-810-4121
  • Fax:
Mailing address:
  • Phone: 865-500-1823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009807
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12001
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: