Individual
MRS. KELLY R RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
800 ZORN AVE, LOUISVILLE, KY 40206-1433
(029) 563-4525
(270) 735-1978
Mailing address
914 N DIXIE AVE, SUITE 304, ELIZABETHTOWN, KY 42701-2520
(270) 769-1049
(270) 735-1978
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA816
KY
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95004131
—
KY
Enumeration date
07/22/2005
Last updated
08/27/2024
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