Healthcare Provider Details

I. General information

NPI: 1467795690
Provider Name (Legal Business Name): AUTUMN ZEA RICHARDSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2013
Last Update Date: 04/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HOSPITAL WAY
SOMERSET KY
42503-2872
US

IV. Provider business mailing address

941 ELIHU RUSH BRANCH RD
SOMERSET KY
42501-5811
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-2600
  • Fax:
Mailing address:
  • Phone: 606-416-8487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007999
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: