Provider Demographics
NPI:1033837851
Name:RITCHEY, TEGAN A (LPM)
Entity Type:Individual
Prefix:
First Name:TEGAN
Middle Name:A
Last Name:RITCHEY
Suffix:
Gender:F
Credentials:LPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 SIERRA VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3033
Mailing Address - Country:US
Mailing Address - Phone:717-673-3287
Mailing Address - Fax:
Practice Address - Street 1:NELLIS AFB 4700 LAS VEGAS BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89191-0000
Practice Address - Country:US
Practice Address - Phone:702-679-9557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN18011164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse