Individual
KELLY LYNAE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5555 E BASELINE RD, MESA, AZ 85206-4709
(480) 393-0575
(480) 704-4019
Mailing address
5555 E BASELINE RD, MESA, AZ 85206-4709
(480) 393-0575
(480) 704-4019
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10561256-1206
UT
363A00000X
Physician Assistant
Primary
7112
AZ
Other
Enumeration date
06/04/2009
Last updated
12/11/2024
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