Provider Demographics
NPI:1508851544
Name:RICHARDSON, AMY KRISTINE (DPM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KRISTINE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16701 CLEVELAND ST STE C
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-0901
Mailing Address - Country:US
Mailing Address - Phone:425-658-0658
Mailing Address - Fax:425-658-5303
Practice Address - Street 1:16701 CLEVELAND ST STE C
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-0901
Practice Address - Country:US
Practice Address - Phone:425-658-0658
Practice Address - Fax:425-658-5303
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000741213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8349482Medicaid
WAP00035081OtherRAILROAD MEDICARE PROVIDER NUMBER
WA2078791Medicaid
WACJ4574OtherRAILROAD MEDICARE GROUP
WAAB37680Medicare ID - Type UnspecifiedKING COUNTY NUMBER
WA4384630004Medicare NSC
WA2078791Medicaid
WA8349482Medicaid
WAG8906903Medicare PIN
WACJ4574OtherRAILROAD MEDICARE GROUP
WAAB37681Medicare ID - Type UnspecifiedPIERCE COUNTY NUMBER
WA4384630003Medicare NSC