Provider Demographics
NPI:1093058117
Name:RICHARDSON, BRITTNEY MYKEIA (MD)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:MYKEIA
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-261-0693
Mailing Address - Fax:502-261-0699
Practice Address - Street 1:9569 TAYLORSVILLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2751
Practice Address - Country:US
Practice Address - Phone:502-261-0693
Practice Address - Fax:502-261-0699
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY49615207Q00000X
KYR3314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100308620 (KOHMG)Medicaid
KY7100308620 (KOHMG)Medicaid
KYK178011 (KOHMG)Medicare PIN