Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 9207 | CT |
NPI | 1033726856 |
---|---|
Provider Name | Mekessia Richards-Carby |
First Address | New Haven, CT 06511-5991 |
Second Address | New Haven, CT 06511-5991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2020 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004217099 | (05) | CT |
008039745 | (05) | CT |
008056033 | (05) | CT |
008056168 | (05) | CT |
008068298 | (05) | CT |
008098243 | (05) | CT |