Provider Demographics
NPI:1073791943
Name:RICHARDSON, KAKEASHA SHANIKA (PA-C)
Entity Type:Individual
Prefix:
First Name:KAKEASHA
Middle Name:SHANIKA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAKEASHA
Other - Middle Name:SHANIKA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0986
Mailing Address - Country:US
Mailing Address - Phone:919-693-6541
Mailing Address - Fax:919-693-7396
Practice Address - Street 1:110 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2576
Practice Address - Country:US
Practice Address - Phone:919-693-6541
Practice Address - Fax:919-693-7396
Is Sole Proprietor?:No
Enumeration Date:2008-02-03
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01236363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant