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General NPI Number Information
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NPI Number | 1548916810
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Entity Type | Organization
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Legal Business Name | SHACONYA L RICHARDSON
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 02/25/2022
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Provider Practice Location Address
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Address Line | 714 LYNDON LN STE 6
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City | LOUISVILLE
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State | KY
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Zip | 40222-4643
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Country | US
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Telephone | 502-225-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 6007 COUNT TURF DR
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City | LOUISVILLE
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State | KY
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Zip | 40272-3549
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Country | US
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Telephone | 502-243-5565
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING AGENT
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Name | STEVEN C MITCHELL
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Credential |
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Telephone | 502-654-3927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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