Healthcare Provider Details

I. General information

NPI: 1124984067
Provider Name (Legal Business Name): JUSTIN RICHEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 HIDDEN VALLEY EST
GLASGOW KY
42141-7887
US

IV. Provider business mailing address

54 HIDDEN VALLEY EST
GLASGOW KY
42141-7887
US

V. Phone/Fax

Practice location:
  • Phone: 270-590-9394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1121791
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: