Provider Demographics
NPI:1003637943
Name:RICHARD, RACHEL JANE (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:JANE
Last Name:RICHARD
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 1:11227 S KESTREL RISE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5145
Mailing Address - Country:US
Mailing Address - Phone:410-937-2166
Mailing Address - Fax:
Practice Address - Street 1:12176 S 1000 E STE 4
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-3221
Practice Address - Country:US
Practice Address - Phone:801-572-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14176439-1206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine