Provider Demographics
NPI:1033726856
Name:RICHARDS-CARBY, MEKESSIA (APRN)
Entity Type:Individual
Prefix:
First Name:MEKESSIA
Middle Name:
Last Name:RICHARDS-CARBY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2920
Mailing Address - Country:US
Mailing Address - Phone:860-655-4986
Mailing Address - Fax:203-781-4624
Practice Address - Street 1:566 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105
Practice Address - Country:US
Practice Address - Phone:860-655-4986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9207363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008039745Medicaid
CT008056168Medicaid
CT008098243Medicaid
CT004217099Medicaid
CT008056033Medicaid
CT008068298Medicaid