MEDICARE: MARY RICHARDSON PA-C

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	363AM0700X	Medical Physician Assistant	PA597	KY
2	363AS0400X	Surgical Physician Assistant	PA597	KY
3	363A00000X	Physician Assistant	PA597	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760497283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY RICHARDSON PA-C

Provider Business Mailing Address
First Line	:	900 S LIMESTONE CTW 324
Second Line	:	DIVISION OF CARDIOLOGY
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0200
Country	:	US
Telephone Number	:	859-323-3976
Fax Number	:	859-257-6060

Provider Business Practice Location Address
First Line	:	800 ROSE ST
Second Line	:	DIVISION OF CARDIOLOGY
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0200
Country	:	US
Telephone Number	:	859-323-3976
Fax Number	:	859-257-6060

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	08/28/2025

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Directions to “ MARY RICHARDSON PA-C” Practice Location

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