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General NPI Number Information
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NPI Number | 1811637713
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Entity Type | Individual
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Provider Name | KIM RICHARDSON
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Gender | Female
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 03/30/2022
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Provider Practice Location Address
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Address Line | 2800 PEOPLES ST STE 90
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City | JOHNSON CITY
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State | TN
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Zip | 37604-4158
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Country | US
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Telephone | 423-928-0345
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Fax |
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Provider Business Mailing Address
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Address Line | 218 KEEFAUVER RD
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City | JOHNSON CITY
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State | TN
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Zip | 37615-4409
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Country | US
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Telephone | 423-676-5863
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 3764
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License Number State | TN
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