Provider Demographics
NPI:1649020389
Name:RICHARDSON, KRISTIEN M
Entity type:Individual
Prefix:
First Name:KRISTIEN
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2530
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-2530
Mailing Address - Country:US
Mailing Address - Phone:980-259-2498
Mailing Address - Fax:704-997-5525
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8096
Practice Address - Country:US
Practice Address - Phone:980-259-2498
Practice Address - Fax:704-997-5525
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily