Healthcare Provider Details

I. General information

NPI: 1801182035
Provider Name (Legal Business Name): BRYAN L RICHARDSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S SANTA FE AVE # 260
SALINA KS
67401-4190
US

IV. Provider business mailing address

2414 N LINDBERG ST
WICHITA KS
67226-3625
US

V. Phone/Fax

Practice location:
  • Phone: 785-827-2238
  • Fax:
Mailing address:
  • Phone: 314-503-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number14-105503-122
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-557040-122
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: