Keighley Faye Richardson, PA-C, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

8972 Issued in AZ

Practice address

3330 N 2ND St Ste 401
Phoenix, AZ 85012-2371

Phone

(602) 606-8949

NPI assigned

Oct 12, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1507766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669420800000",
    "number": "1326559790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2253",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850022253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 N 2ND ST STE 401",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850122371",
            "telephone_number": "602-606-8949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KEIGHLEY",
        "middle_name": "FAYE",
        "credential": "PA-C, ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-12",
        "last_updated": "2022-11-26",
        "certification_date": "2022-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AZ",
            "license": "1675",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "8972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125274",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dorian Lorrae Richardson, ND
• Elise Faye Richardson, DPT
• Gregory Willett Richardson
• Hailey B Richardson
• Jordan Richardson, DPM
• Keri Lynn Richardson, PA-C
• Kitty Lee Richardson
• Landon C Richardson, DNP
• Leesha Nicole Richardson, AGNP-C
• Logan Richardson, OTR/L

• Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2022; 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.