Provider Demographics
NPI:1942089875
Name:RICHARDSON, KATHRYN SNIDER (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SNIDER
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:165 SPRINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9650
Mailing Address - Country:US
Mailing Address - Phone:931-494-7179
Mailing Address - Fax:
Practice Address - Street 1:8504 SIX FORKS RD STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3265
Practice Address - Country:US
Practice Address - Phone:919-999-4144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily