Healthcare Provider Details

I. General information

NPI: 1356312458
Provider Name (Legal Business Name): SEQUITA L RICHARDSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 E GREGORY BLVD STE A
RAYTOWN MO
64133-6506
US

IV. Provider business mailing address

9300 E GREGORY BLVD STE A
RAYTOWN MO
64133-6506
US

V. Phone/Fax

Practice location:
  • Phone: 816-946-6930
  • Fax: 855-813-5433
Mailing address:
  • Phone: 816-946-6930
  • Fax: 855-813-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 113087
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number113087
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: