Healthcare Provider Details

I. General information

NPI: 1588503379
Provider Name (Legal Business Name): RICHELLE RADCLIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SETON PKWY STE 203
ROUND ROCK TX
78665-8003
US

IV. Provider business mailing address

301 SETON PKWY STE 203
ROUND ROCK TX
78665-8003
US

V. Phone/Fax

Practice location:
  • Phone: 512-481-4010
  • Fax:
Mailing address:
  • Phone: 305-842-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: