=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730088576
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN ADAH RICHEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2026
-----------------------------------------------------
Last Update Date | 11/05/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2801 GRAND AVE STE 1150
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-4677
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-223-0509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N 3RD AVE
-----------------------------------------------------
City | HUXLEY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50124-9420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-223-0509
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | TAT-A-1461
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------