Provider Demographics
NPI:1235477647
Name:RITCHIE, JEANNE MARIE
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:MARIE
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:MARIE
Other - Last Name:JAHELKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:225 CLARKSON RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2278
Mailing Address - Country:US
Mailing Address - Phone:636-230-5050
Mailing Address - Fax:636-230-5057
Practice Address - Street 1:225 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2278
Practice Address - Country:US
Practice Address - Phone:636-230-5050
Practice Address - Fax:636-230-5057
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO146890005Medicare PIN