Provider Demographics
NPI:1013220771
Name:RICHARDSON, KYLE ANTHONY
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:ANTHONY
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BREEDS HILL RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1881
Mailing Address - Country:US
Mailing Address - Phone:508-775-0275
Mailing Address - Fax:
Practice Address - Street 1:206 BREEDS HILL RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1881
Practice Address - Country:US
Practice Address - Phone:508-775-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator