Provider Demographics
NPI:1467183038
Name:RICHARDSON, KEYAH PAIGE (PA-C)
Entity type:Individual
Prefix:MRS
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 1:2305 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-6203
Practice Address - Country:US
Practice Address - Phone:620-801-3320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02687207QA0505X, 207QA0000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant