Individual
MR. COREY R RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
501 SE 172ND AVE, VANCOUVER, WA 98684-9542
(360) 397-1500
(360) 604-1771
Mailing address
700 NE 87TH AVE, VANCOUVER, WA 98664
(360) 397-1500
(360) 604-1771
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA00946
OR
363A00000X
Physician Assistant
Primary
PA10005059
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8462046
—
WA
Enumeration date
07/18/2006
Last updated
12/02/2009
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