Provider Demographics
NPI:1518333434
Name:RICHARDSON, KRISTAN (LAC)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4391 N RANGER RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-7312
Mailing Address - Country:US
Mailing Address - Phone:215-237-3936
Mailing Address - Fax:
Practice Address - Street 1:623 MILLER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2302
Practice Address - Country:US
Practice Address - Phone:215-237-3936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV96225171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist