Provider Demographics
NPI:1043296593
Name:RITCHEY, KENDALE L (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDALE
Middle Name:L
Last Name:RITCHEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32569
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-2569
Mailing Address - Country:US
Mailing Address - Phone:865-694-0062
Mailing Address - Fax:865-694-7907
Practice Address - Street 1:9314 PARK WEST BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4330
Practice Address - Country:US
Practice Address - Phone:865-692-1260
Practice Address - Fax:865-692-1189
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM487213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN480026875OtherRAILROAD MEDICARE
TN3352563Medicaid
TN3352563Medicare PIN
TN3352563Medicaid
TN0677340007Medicare NSC