1760524730 NPI number — MRS. KRISTEN KELLI RICHARDSON P.T.

Table of content: MRS. KRISTEN KELLI RICHARDSON P.T. (NPI 1760524730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760524730 NPI number — MRS. KRISTEN KELLI RICHARDSON P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDSON
Provider First Name:
KRISTEN KELLI
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDSON
Provider Other First Name:
KELLI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1760524730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23372
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59104-3372
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-672-7844
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 14TH ST W STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59102-5364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-672-7844
Provider Business Practice Location Address Fax Number:
406-248-8829
Provider Enumeration Date:
02/13/2007

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: 225100000X , with the licence number:  1786 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000060203 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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