Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 392 | AZ |
Y | 222Z00000X | Podiatrist | 392 | AZ |
NPI | 1073500237 |
---|---|
Provider Name | Kathleen Richards |
First Address | Fountain Hills, AZ 85268-5537 |
Second Address | Fountain Hills, AZ 85268-5537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 11/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001233945 | (05) | AZ |
2Z0413 | HEALTH NET (01) | AZ |
AZ0193680 | BCBS (01) | AZ |
U42039 | (02) | AZ |