Provider Demographics
NPI:1255887667
Name:RICHMOND, TORY
Entity type:Individual
Prefix:
First Name:TORY
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W 8TH ST APT 702
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-1576
Mailing Address - Country:US
Mailing Address - Phone:816-787-6831
Mailing Address - Fax:
Practice Address - Street 1:8424 E SHEA BLVD
Practice Address - Street 2:101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6662
Practice Address - Country:US
Practice Address - Phone:480-256-1520
Practice Address - Fax:480-478-6628
Is Sole Proprietor?:No
Enumeration Date:2016-08-27
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009027351163W00000X
AZ107773367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse