Individual
KEVIN RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
24 ANTRIM COMMONS DR, GREENCASTLE, PA 17225-1623
(717) 593-0512
(717) 839-6810
Mailing address
601 MEMORY LN, YORK, PA 17402-2231
(717) 851-1405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C005975
MD
363A00000X
Physician Assistant
MA057870
PA
363A00000X
Physician Assistant
OA003639
PA
363AM0700X
Medical Physician Assistant
C05975
MD
363AM0700X
Medical Physician Assistant
Primary
MA057870
PA
363AM0700X
Medical Physician Assistant
OA003639
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103887352
—
PA
01
—
14140910
CAQH
—
01
—
1861864852
NPI
—
Enumeration date
10/29/2015
Last updated
02/05/2025
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