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Individual

NICHOLAS RICHARDS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1 BOONE RD, BREMERTON, WA 98312-1894
(360) 475-4721
Mailing address
1 BOONE RD, BREMERTON, WA 98312-1894
(360) 475-4000

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
11469067-1206
UT
363AM0700X
Medical Physician Assistant
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11469067-1206
UTAH LICENSE
UT
01
11469067-8906
UTAH CS 2-5 LICENSE
UT
Enumeration date
11/23/2016
Last updated
01/11/2024
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