Provider Demographics
NPI:1891220927
Name:RICHARDSON, TIERNEY (PA-C)
Entity Type:Individual
Prefix:
First Name:TIERNEY
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
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 1:22 PATRIOT PL
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1375
Mailing Address - Country:US
Mailing Address - Phone:508-718-4050
Mailing Address - Fax:508-718-4051
Practice Address - Street 1:22 PATRIOT PL
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1375
Practice Address - Country:US
Practice Address - Phone:508-718-4050
Practice Address - Fax:508-718-4051
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant