Provider Demographics
NPI:1073847034
Name:RITZDORF, KYRIE GIANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KYRIE
Middle Name:GIANNE
Last Name:RITZDORF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 S SANTA FE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4189
Mailing Address - Country:US
Mailing Address - Phone:785-452-7245
Mailing Address - Fax:785-452-7246
Practice Address - Street 1:501 S SANTA FE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4189
Practice Address - Country:US
Practice Address - Phone:785-452-7245
Practice Address - Fax:785-452-7246
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2574363A00000X
KS15-01326363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200633200AMedicaid
KS3000433763001Medicaid