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General NPI Number Information
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NPI Number | 1639960073
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Entity Type | Individual
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Provider Name | DAKOTA RICHERSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 1520 S LIBERTY DR
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5167
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Country | US
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Telephone | 812-676-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 1456 ROGERS RD
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City | WEST FRANKFORT
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State | IL
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Zip | 62896-5452
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10004895A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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