1801381645 NPI number — MRS. KRYSTEN LEEANN RICHARDSON PHYSICIAN ASSISTANT

Table of content: MRS. KRYSTEN LEEANN RICHARDSON PHYSICIAN ASSISTANT (NPI 1801381645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801381645 NPI number — MRS. KRYSTEN LEEANN RICHARDSON PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON
Provider First Name:
KRYSTEN
Provider Middle Name:
LEEANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROSSLIN
Provider Other First Name:
KRYSTEN
Provider Other Middle Name:
LEEANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICIAN ASSISTANT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801381645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1751 VETERANS DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35630-4930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-718-3200
Provider Business Mailing Address Fax Number:
256-246-3297

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1751 VETERANS DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35630-4930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-718-3200
Provider Business Practice Location Address Fax Number:
256-246-3297
Provider Enumeration Date:
06/25/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  3576 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 1346 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 267297 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q037209 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".