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General NPI Number Information
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NPI Number | 1801381645
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Entity Type | Individual
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Provider Name | KRYSTEN LEEANN RICHARDSON PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 1751 VETERANS DR STE 300
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City | FLORENCE
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State | AL
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Zip | 35630-4930
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Country | US
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Telephone | 256-718-3200
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Fax | 256-246-3297
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Provider Business Mailing Address
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Address Line | 1751 VETERANS DR STE 300
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City | FLORENCE
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State | AL
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Zip | 35630-4930
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Country | US
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Telephone | 256-718-3200
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Fax | 256-246-3297
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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 | 3576
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1346
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License Number State | AL
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