KELLY RICHARDSON MD05/ NPI 1548278971

NPI Information

  • NPI: 1548278971
  • Provider Name: KELLY RICHARDSON, MD05/
  • Classification: Internal Medicine - 207RA0000X
  • Specialization: Adolescent Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1200 56TH ST SW
    WYOMING, MI
    ZIP 49509
  • Phone: (616) 243-5707

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NPI Details

Kelly Richardson, MD05/ is an adolescent medicine internal medicine in Wyoming, MI. The provider is an internist who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. Kelly Richardson, MD05/ NPI is 1548278971. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1200 56TH ST SW
WYOMING, MI
ZIP 49509-704
Phone: (616) 243-5707
Fax: (616) 243-1170

The NPI 1548278971 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/3/2006 and was last updated on 10/18/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207R00000XInternal Medicine4301079769MICHIGANNo
2207RA0000XInternal MedicineAdolescent Medicine4301079769MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1I64617MEDICARE UPIN
2381360529OTHERMICHIGANTAX ID
3P25800003MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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