Healthcare Provider Details

I. General information

NPI: 1467183038
Provider Name (Legal Business Name): KEYAH PAIGE RICHARDSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 CENTRAL AVE
DODGE CITY KS
67801-6203
US

IV. Provider business mailing address

PO BOX 5
SUBLETTE KS
67877-0005
US

V. Phone/Fax

Practice location:
  • Phone: 620-801-3320
  • Fax: 620-225-8687
Mailing address:
  • Phone: 620-360-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number15-02687
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number15-02687
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02687
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: