Provider Demographics
NPI:1861483984
Name:RICHARDSON, KRISTOPHER L (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271190
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1190
Mailing Address - Country:US
Mailing Address - Phone:361-993-4835
Mailing Address - Fax:361-993-7043
Practice Address - Street 1:6000 S STAPLES ST
Practice Address - Street 2:SUITE 406
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2952
Practice Address - Country:US
Practice Address - Phone:361-993-4835
Practice Address - Fax:361-993-7043
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02807363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216948402Medicaid
TXTXB110235Medicare PIN