Kim Richardson

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

3764 Issued in TN

Practice address

2800 Peoples St Ste 90
Johnson City, TN 37604-4158

Phone

(423) 928-0345

NPI assigned

Mar 30, 2022

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Johnson City Smiles, LLC

  • General Practice Dentistry
  • Johnson City, TN
  • NPI 1255997359
  NPD (past)

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1811637713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 KEEFAUVER RD",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376154409",
            "telephone_number": "423-676-5863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 PEOPLES ST STE 90",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044158",
            "telephone_number": "423-928-0345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KIM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-03-30",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "TN",
            "license": "3764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lawrence Rice, PHD
• Janessa Rich, MD
• Richard D Ballard DC
• Monique Richard, MS, RDN, LDN
• Kaley Richards, M.S., CCC-SLP
• Samuel Lee Richmond, PHARMD
• Kristen Alora Ricker
• Stephanie Grindstaff Ricker, BS
• Karly Riddle, PHARMD
• Mikala Riddlesworth, PHYSICIAN ASSISTANT

• Dental Hygienist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Dental Hygienist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.