Healthcare Provider Details

I. General information

NPI: 1841300183
Provider Name (Legal Business Name): KRISTEN PAIGE RICHARDSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1231 PARK PL NE SUITE FALCON
CEDAR RAPIDS IA
52402-2018
US

IV. Provider business mailing address

1231 PARK PL NE SUITE FALCON
CEDAR RAPIDS IA
52402-2018
US

V. Phone/Fax

Practice location:
  • Phone: 319-521-4716
  • Fax: 319-294-9356
Mailing address:
  • Phone: 319-521-4716
  • Fax: 319-294-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG095377
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier202332407
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: