1700809043 NPI number — KATHLEEN JEANNETTE RICHARDSON ARNP - FNP

Table of content: KATHLEEN JEANNETTE RICHARDSON ARNP - FNP (NPI 1700809043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700809043 NPI number — KATHLEEN JEANNETTE RICHARDSON ARNP - FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON
Provider First Name:
KATHLEEN
Provider Middle Name:
JEANNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP - FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700809043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MADIGAN ARMY MEDICAL CTR
Provider Second Line Business Mailing Address:
9040 REID ST. ATTN: MCHJ-QCR
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431-1100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-968-2252
Provider Business Mailing Address Fax Number:
253-968-3278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 E 67TH ST STE 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98404-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-212-0202
Provider Business Practice Location Address Fax Number:
253-212-0962
Provider Enumeration Date:
07/26/2006

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: 363LF0000X , with the licence number:  AP30007392 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2075947 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2086163 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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