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1760497283 NPI number — MARY RICHARDSON PA-C

NPI Number: 1760497283
Health Care Provider/Practitioner: MARY RICHARDSON PA-C

Information about “1760497283” NPI (MARY RICHARDSON PA-C) exists in 1760497283 in HTML format HTML  |  1760497283 in plain Text format TXT  |  1760497283 in PDF (Portable Document Format) PDF  |  1760497283 in an XML format XML  formats.

NPI Number : 1760497283 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760497283",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RICHARDSON",
    "FirstName": "MARY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "VANDERHOOF",
    "OtherFirstName": "MARY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "900 S LIMESTONE CTW 324",
    "SecondLineMailingAddress": "DIVISION OF CARDIOLOGY",
    "MailingAddressCityName": "LEXINGTON",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40536-0200",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "859-323-3976",
    "MailingAddressFaxNumber": "859-257-6060",
    "FirstLinePracticeLocationAddress": "800 ROSE ST",
    "SecondLinePracticeLocationAddress": "DIVISION OF CARDIOLOGY",
    "PracticeLocationAddressCityName": "LEXINGTON",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40536-0200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "859-323-3976",
    "PracticeLocationAddressFaxNumber": "859-257-6060",
    "EnumerationDate": "07/31/2006",
    "LastUpdateDate": "08/28/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "PA597",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AS0400X",
          "TaxonomyName": "Surgical Physician Assistant",
          "LicenseNumber": "PA597",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA597",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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