Provider Demographics
NPI:1912549312
Name:RICH, COLLEEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:OHARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1513 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-5972
Mailing Address - Country:US
Mailing Address - Phone:919-230-2655
Mailing Address - Fax:919-462-7012
Practice Address - Street 1:1513 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-5972
Practice Address - Country:US
Practice Address - Phone:919-230-2655
Practice Address - Fax:919-462-7012
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC0010-09568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant