Provider Demographics
NPI:1265007678
Name:REICHERT, GAGE ANDREW
Entity Type:Individual
Prefix:
First Name:GAGE
Middle Name:ANDREW
Last Name:REICHERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 1500TH RD
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:KS
Mailing Address - Zip Code:67635-9518
Mailing Address - Country:US
Mailing Address - Phone:785-545-8670
Mailing Address - Fax:
Practice Address - Street 1:514 1500TH RD
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:KS
Practice Address - Zip Code:67635-9518
Practice Address - Country:US
Practice Address - Phone:785-545-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02514363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant