Kelly Lynae Richardson, PA-C
Physician Assistant in Mesa, AZ. Individual provider (NPI-1).
NPI number1760618730
StatusActive
Last updated in NPPESDec 11, 2024
Details
- NPI
- 1760618730
- Entity type
- Individual (NPI-1)
- Name
- Kelly Lynae Richardson
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 4, 2009
- Certification date
- Dec 11, 2024
- Last updated
- Dec 11, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 7112 | AZ | Yes |
| 363A00000X | Physician Assistant | 10561256-1206 | UT |
Practice location
5555 E Baseline RdMesa, AZ 85206-4709
Phone 480-393-0575 · Fax 480-704-4019
Mailing address
5555 E Baseline RdMesa, AZ 85206-4709
Phone 480-393-0575 · Fax 480-704-4019
Other practice locations
2045 Franklin St
Denver, CO 80205-5437
Denver, CO 80205-5437
Phone 303-203-3797
5121 S Cottonwood St Ste 320
Murray, UT 84107-5701
Murray, UT 84107-5701
Phone 801-507-3380
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All 472 Physician Assistant providers in Mesa · All 13,507 providers in Mesa
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