Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2016011684 | MO |
N | 208000000X | Pediatrician | MD82552 | SC |
Y | 2080P0208X | Pediatric Infectious Diseases | 82552 | SC |
NPI | 1124466164 |
---|---|
Provider Name | Katherine Marie Richardson |
First Address | Greenville, SC 29601-2842 |
Second Address | Greenville, SC 29615-3580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2013 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
825520 | (05) | SC |