Healthcare Provider Details

I. General information

NPI: 1124816624
Provider Name (Legal Business Name): RICHMOND HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BAXTER AVE STE 125
LOUISVILLE KY
40204-1103
US

IV. Provider business mailing address

1939 TREVILIAN WAY
LOUISVILLE KY
40205-2139
US

V. Phone/Fax

Practice location:
  • Phone: 812-267-6367
  • Fax:
Mailing address:
  • Phone: 812-267-6367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY JANE RICHMOND
Title or Position: OWNER
Credential: DNP APRN
Phone: 812-267-6367