Provider Demographics
NPI:1922156330
Name:RICHARDS, KALEEN R (CNM, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KALEEN
Middle Name:R
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3102
Mailing Address - Country:US
Mailing Address - Phone:407-878-2757
Mailing Address - Fax:407-288-8530
Practice Address - Street 1:165 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3102
Practice Address - Country:US
Practice Address - Phone:407-878-2757
Practice Address - Fax:407-288-8530
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9170873367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307899000Medicaid