Healthcare Provider Details

I. General information

NPI: 1962992164
Provider Name (Legal Business Name): MALORY LYNN RICHARDSON NP, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N EAGLE CREEK DR STE 320
LEXINGTON KY
40509-1893
US

IV. Provider business mailing address

741 TROY TRL
LEXINGTON KY
40517-1958
US

V. Phone/Fax

Practice location:
  • Phone: 859-523-2526
  • Fax: 859-523-2532
Mailing address:
  • Phone: 812-344-1926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number3012082
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number3012082
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: