Healthcare Provider Details

I. General information

NPI: 1437117546
Provider Name (Legal Business Name): KELLY D. RICHARDSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 05/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 EVELYN BYRD AVE
HARRISONBURG VA
22801-3487
US

IV. Provider business mailing address

1871 EVELYN BYRD AVE
HARRISONBURG VA
22801-3487
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-5800
  • Fax: 540-564-5801
Mailing address:
  • Phone: 540-564-5800
  • Fax: 540-564-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: