Provider Demographics
NPI:1235681636
Name:RICHARDSON, KAYLA (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1975 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3811
Mailing Address - Country:US
Mailing Address - Phone:937-439-6186
Mailing Address - Fax:
Practice Address - Street 1:1975 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3811
Practice Address - Country:US
Practice Address - Phone:937-439-6186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
OH50.008048RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer