Healthcare Provider Details

I. General information

NPI: 1235897778
Provider Name (Legal Business Name): BRIAN RICHARDSON NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 BIG HILL AVE STE 2
RICHMOND KY
40475-2501
US

IV. Provider business mailing address

840 BOONE CREEK RD
STANTON KY
40380-9578
US

V. Phone/Fax

Practice location:
  • Phone: 859-749-5370
  • Fax:
Mailing address:
  • Phone: 859-428-7956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3017052
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: