Provider Demographics
NPI:1962992164
Name:RICHARDSON, MALORY LYNN (NP, WHNP)
Entity type:Individual
Prefix:MRS
First Name:MALORY
Middle Name:LYNN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 TROY TRL
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1958
Mailing Address - Country:US
Mailing Address - Phone:812-344-1926
Mailing Address - Fax:
Practice Address - Street 1:151 N EAGLE CREEK DR STE 320
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1893
Practice Address - Country:US
Practice Address - Phone:859-523-2526
Practice Address - Fax:859-523-2532
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012082364SW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health