Richardson, Kelly Diane
Richardson, Kelly Diane is an individual health care provider with primary practice located at 212 Linden Dr Suite 150, Winchester VA 22601-2894. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Richardson, Kelly Diane can be contacted via phone (337) 493-5163.Contact Information
Primary practice address
212 Linden Dr Suite 150
Winchester VA 22601-2894
Phone: (337) 493-5163
Fax: (337) 439-5866
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 60563 | Kansas |
| Dental Providers / Dentist | 122300000X | 6038 | Louisiana |
| Dental Providers / Dentist | 122300000X | 0401412717 | Virginia |
| Dental Providers / Dentist | 122300000X | 27594 | Texas |
Profile Details
| NPI number | 1528229416 |
|---|---|
| LBN Legal business name | Richardson, Kelly Diane |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 23rd, 2008 |
| Last updated | Jun 26th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528229416 | NPPES |
| Kansas | MEDICAID | 100456320Q | |
| Kansas | MEDICAID | 1860387 |
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