Organization
THR PEDIATRICS & WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TYESHIA CHLOTIEL HALSELL RICHARDS DMSC, PA-C (PEDIATRIC PHYSICIAN ASSISTANT)
(502) 500-8955
Entity
Organization
Contact information
Practice address
7098 DISTRIBUTION DR STE A, LOUISVILLE, KY 40258-2879
(502) 749-8019
(833) 755-1833
Mailing address
9905 BROOKS BEND RD, LOUISVILLE, KY 40258-4638
(502) 749-8019
(833) 755-1833
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100773670
—
KY
Enumeration date
06/17/2021
Last updated
11/03/2021
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