MEDICARE: KATELYN MARY RICHARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant		CT

General Provider Information

NPI Number	:	1255267001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN MARY RICHARD

Provider Business Mailing Address
First Line	:	345 REEF RD UNIT 4
Second Line	:
City	:	FAIRFIELD
State	:	CT
Zip	:	06824-6584
Country	:	US
Telephone Number	:	860-502-5651
Fax Number	:

Provider Business Practice Location Address
First Line	:	780 LITCHFIELD ST
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-6268
Country	:	US
Telephone Number	:	860-482-8578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2026
Last Update Date	:	06/19/2026

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Directions to “ KATELYN MARY RICHARD ” Practice Location

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