Provider Demographics
NPI:1285316380
Name:RICHARD, KRIS B
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:B
Last Name:RICHARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W CHURCH ST APT C1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1554
Mailing Address - Country:US
Mailing Address - Phone:740-641-4081
Mailing Address - Fax:
Practice Address - Street 1:1600 W CHURCH ST APT C1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1554
Practice Address - Country:US
Practice Address - Phone:740-641-4081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant