Healthcare Provider Details

I. General information

NPI: 1518884527
Provider Name (Legal Business Name): MR. KELVIN RICHARDSON SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 FLORENCE AVE
CLARKSDALE MS
38614-2401
US

IV. Provider business mailing address

341 FLORENCE AVE
CLARKSDALE MS
38614-2401
US

V. Phone/Fax

Practice location:
  • Phone: 346-313-6578
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: