Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 33069 | KY |
NPI | 1003810920 |
---|---|
Provider Name | Julia E Richerson |
First Address | Louisville, KY 40295-0244 |
Second Address | Louisville, KY 40212-1033 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000307166 | ANTHEM (01) | KY |
64330699 | (05) | KY |
G30214 | (02) |