Provider Demographics
NPI:1215231394
Name:RICHARDSON, BRENDAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:BRENDAN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:CHANDLER MC MS-463
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-323-0100
Mailing Address - Fax:859-257-1940
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:CHANDLER MC MS-463
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-0100
Practice Address - Fax:859-257-1940
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant