Provider Demographics
NPI:1033558820
Name:RICHARDSON, TARA L (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 LAMAR AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3299
Mailing Address - Country:US
Mailing Address - Phone:913-826-4200
Mailing Address - Fax:913-826-1589
Practice Address - Street 1:6000 LAMAR AVE STE 130
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202
Practice Address - Country:US
Practice Address - Phone:913-826-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94082292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry