Healthcare Provider Details

I. General information

NPI: 1982158564
Provider Name (Legal Business Name): KIMBERLY RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 MARSHALL AVE APT A
NORFOLK VA
23504-2636
US

IV. Provider business mailing address

2224 MARSHALL AVE APT A
NORFOLK VA
23504-2636
US

V. Phone/Fax

Practice location:
  • Phone: 757-952-8755
  • Fax: 757-822-6162
Mailing address:
  • Phone: 757-952-8755
  • Fax: 757-822-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number919448
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: