=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225200546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARA JO RICHARDSON P.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2008
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 SE PLAZA AVE STE 5
-----------------------------------------------------
City | BENTONVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72712-5473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-273-3376
-----------------------------------------------------
Fax | 479-273-3468
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1651 E STEARNS ST STE 110
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72703-6196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-876-8550
-----------------------------------------------------
Fax | 479-208-4266
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA-310
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------