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KELLY RICHARDSON MD05/ NPI 1548278971


NPI Information

NPI: 1548278971
Provider Name: KELLY RICHARDSON, MD05/
Classification: Internal Medicine - 207RA0000X
Entity Type: Individual

Specialization: Adolescent Medicine

PECOS Registration: Yes

Address:
1200 56TH ST SW
WYOMING, MI
ZIP 49509
Phone: (616) 243-5707
Get Directions

Kelly Richardson, MD05/ is an adolescent medicine internal medicine in Wyoming, MI with 22 years of experience. The provider is an internist who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. Kelly Richardson, MD05/ NPI is 1548278971. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: MICHIGAN STATE UNIVERSITY COLLEGE OF HUMAN MEDICINE
Graduation Year:2002

The provider's business location address is:

1200 56TH ST SW
WYOMING, MI
ZIP 49509-704
Phone: (616) 243-5707
Fax: (616) 243-1170

The NPI 1548278971 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/3/2006 and was last updated on 10/18/2011.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal Medicine4301079769MICHIGANNo
2207RA0000XInternal MedicineAdolescent Medicine4301079769MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1I64617MEDICARE UPIN
2381360529OTHERMICHIGANTAX ID
3P25800003MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.