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General NPI Number Information
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NPI Number | 1003637943
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Entity Type | Individual
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Provider Name | RACHEL JANE RICHARD PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 12176 S 1000 E STE 4
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City | DRAPER
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State | UT
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Zip | 84020-3221
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Country | US
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Telephone | 801-572-3750
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Fax |
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Provider Business Mailing Address
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Address Line | 11227 S KESTREL RISE RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84009-5145
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Country | US
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Telephone | 410-937-2166
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14176439-1206
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License Number State | UT
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