Nicholas Richards, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

11469067-1206 Issued in UT

Practice address

1 Boone Rd
Bremerton, WA 98312-1894

Phone

(360) 475-4721

NPI assigned

Nov 23, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1164965109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BOONE RD",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983121894",
            "telephone_number": "360-475-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BOONE RD",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983121894",
            "telephone_number": "360-475-4721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "937 Franklin Blvd",
            "address_purpose": "LOCATION",
            "city": "Lemoore",
            "state": "CA",
            "postal_code": "932464700",
            "country_code": "US",
            "telephone_number": "998-559-2822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDS",
        "first_name": "NICHOLAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-11-23",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "11469067-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTAH CS 2-5 LICENSE",
            "identifier": "11469067-8906",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UTAH LICENSE",
            "identifier": "11469067-1206",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie Rhodes
• Pamela Lynn Rhodes, MA
• Jacie M Rice, BA
• Karen Andrea Richard
• Michael Gene Richards
• Rhianna Richards, R.D.
• Ann Beatrice Richardson, RN
• Chunisty Richardson
• Joshua Richardson
• Lauren D Richardson

• Medical Physician Assistant in Bremerton, WA
• Providers in Bremerton, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; 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.