Organization
SHACONYA L RICHARDSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN C MITCHELL (CREDENTIALING AGENT)
(502) 654-3927
Entity
Organization
Contact information
Practice address
714 LYNDON LN STE 6, LOUISVILLE, KY 40222-4643
(502) 225-4900
Mailing address
6007 COUNT TURF DR, LOUISVILLE, KY 40272-3549
(502) 243-5565
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/25/2022
Last updated
02/25/2022
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