Provider Demographics
NPI:1497968366
Name:RICHARDS, NATHAN BOONE (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:BOONE
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:855-656-7325
Practice Address - Street 1:3003 CHARLESTOWN XING
Practice Address - Street 2:SUITE D
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-8302
Practice Address - Country:US
Practice Address - Phone:812-945-5653
Practice Address - Fax:855-656-7325
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071200A207K00000X, 207K00000X, 208000000X
KY45401207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201082460Medicaid
KY7100209280Medicaid
IN201082460Medicaid
IN201082460Medicaid
KY7100209280Medicaid