Healthcare Provider Details

I. General information

NPI: 1861483984
Provider Name (Legal Business Name): KRISTOPHER L RICHARDSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 S STAPLES ST SUITE 406
CORPUS CHRISTI TX
78413-2952
US

IV. Provider business mailing address

PO BOX 271190
CORPUS CHRISTI TX
78427-1190
US

V. Phone/Fax

Practice location:
  • Phone: 361-993-4835
  • Fax: 361-993-7043
Mailing address:
  • Phone: 361-993-4835
  • Fax: 361-993-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02807
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: