Individual
KEIGHLEY FAYE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
3330 N 2ND ST STE 401, PHOENIX, AZ 85012-2371
(602) 606-8949
Mailing address
PO BOX 2253, PHOENIX, AZ 85002-2253
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
1675
AZ
363A00000X
Physician Assistant
Primary
8972
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125274
—
AZ
Enumeration date
10/12/2017
Last updated
11/26/2022
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