MEDICARE: GRACE & KRISTOPHER RICHARDSON PLLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1346906062
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE & KRISTOPHER RICHARDSON PLLC

Provider Business Mailing Address
First Line	:	4400 S PIEDRAS DR STE 217
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1223
Country	:	US
Telephone Number	:	210-831-6968
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 S PIEDRAS DR STE 217
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1223
Country	:	US
Telephone Number	:	210-831-6968
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	KRISTOPHER RICHARDSON
Credential	:	PA
Telephone Number	:	210-831-6968

Provider Enumeration Date	:	11/17/2021
Last Update Date	:	11/17/2021

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