Provider Demographics
NPI:1700865698
Name:KAY, RICHARD A (PA-C)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:KAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:1009 GOLF COURSE RD SE
Mailing Address - Street 2:STE 109
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4705
Mailing Address - Country:US
Mailing Address - Phone:706-886-9693
Mailing Address - Fax:706-886-7843
Practice Address - Street 1:58 BIG A RD
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6017
Practice Address - Country:US
Practice Address - Phone:706-886-9693
Practice Address - Fax:706-886-7843
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2019-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2000-PA25363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM56426739Medicaid