Individual
KIM M. RICHARDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPP & FNP
Contact information
Practice address
4 COMMERCE LN, CANTON, NY 13617-3739
(315) 386-8191
(315) 386-1410
Mailing address
4 COMMERCE LN, CANTON, NY 13617-3739
(315) 386-8191
(315) 386-1410
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
33 332874
NY
363LF0000X
Family Nurse Practitioner
33332874
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
40 401381
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
40401381
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01995615
—
NY
Enumeration date
02/21/2012
Last updated
02/27/2013
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