Provider Demographics
NPI:1659793651
Name:RICHARDS, KELCYE YATES (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELCYE
Middle Name:YATES
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KELCYE
Other - Middle Name:YATES
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:300 WEST FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-1012
Mailing Address - Country:US
Mailing Address - Phone:864-843-5605
Mailing Address - Fax:864-843-0996
Practice Address - Street 1:300 WEST FRONT STREET
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:SC
Practice Address - Zip Code:29657-1012
Practice Address - Country:US
Practice Address - Phone:864-843-5605
Practice Address - Fax:864-843-0996
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL2049363A00000X
SC2049363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant