Kallyn Richardson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SW20839 Issued in FL

Practice address

11478 Harlan Dr
Jacksonville, FL 32218-4052

Phone

(734) 834-0459

NPI assigned

Feb 20, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brave Health Medical Group PA

  • Community/Behavioral Health Agency
  • Miami, FL
  • NPI 1225669161
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1003514936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11478 HARLAN DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11478 HARLAN DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322184052",
            "telephone_number": "734-834-0459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KALLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-20",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW20839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darrick L Richardson, NONE
• Dennis Alphonso Richardson
• Jayla Nykeria Richardson
• John Edward Richardson, O.D.
• Julia Richardson
• Larry Tyrone Richardson, PH.D., LMHC
• Lisa M Richardson, APRN
• Mary Magdalene Richardson
• Melissa K Richardson, CRNA
• Nicole L Richardson, MA, LMHC, LP

• Clinical Social Worker in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.