Provider Demographics
NPI:1467183038
Name:RICHARDSON, KEYAH PAIGE (PA-C)
Entity Type:Individual
Prefix:
First Name:KEYAH
Middle Name:PAIGE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:SUBLETTE
Mailing Address - State:KS
Mailing Address - Zip Code:67877-0005
Mailing Address - Country:US
Mailing Address - Phone:620-360-0344
Mailing Address - Fax:
Practice Address - Street 1:1021 FLEMING ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-6252
Practice Address - Country:US
Practice Address - Phone:620-287-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant