Individual
MRS. TYESHIA HALSELL RICHARDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7098 DISTRIBUTION DR, STE A, LOUISVILLE, KY 40258-2879
(502) 749-8019
(833) 755-1833
Mailing address
7098 DISTRIBUTION DR STE A, LOUISVILLE, KY 40258-2879
(502) 749-8019
(833) 755-1833
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1121
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100212250
—
KY
Enumeration date
08/25/2008
Last updated
11/03/2021
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