Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kelly Lynae Richardson, PA-C

Individual provider Physician Assistant · NPI 1760618730

Kelly Lynae Richardson, PA-C is a Physician Assistant in Mesa, Arizona. Qualified in 2017, 9 years ago. Practices with Banner Physician Specialists Arizona LLC, a 372-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Arizona and Utah.

Years since qualifying
9
Licensed in
AZ, UT
In the registry since
2009
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

5555 E Baseline Rd
Mesa, AZ 85206-4709
Phone: (480) 393-0575
Fax: (480) 704-4019
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 2045 Franklin St, Denver, CO 80205-5437 — (303) 203-3797
  • 5121 S Cottonwood St Ste 320, Murray, UT 84107-5701 — (801) 507-3380

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7112 (AZ)
Physician Assistant Taxonomy 363A00000X · Licence 10561256-1206 (UT)

Record details

NPI number1760618730
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 4, 2009
Last updated in NPPESDecember 11, 2024
Certification dateDecember 11, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Banner Physician Specialists Arizona Llc — 372 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Mesa