Provider Demographics
NPI:1497911465
Name:RICHARDSON, KATHLEEN BRYANT (NP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BRYANT
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12706 MCMANUS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4460
Mailing Address - Country:US
Mailing Address - Phone:757-874-2229
Mailing Address - Fax:757-874-7525
Practice Address - Street 1:12706 MCMANUS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4460
Practice Address - Country:US
Practice Address - Phone:757-874-2229
Practice Address - Fax:757-874-7525
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA001700057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024079555OtherLICENSE