Provider Demographics
NPI:1578065736
Name:SIMON, RITCHEY SUSANN (DNP)
Entity Type:Individual
Prefix:
First Name:RITCHEY
Middle Name:SUSANN
Last Name:SIMON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WATSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PRATT
Mailing Address - State:KS
Mailing Address - Zip Code:67124-3092
Mailing Address - Country:US
Mailing Address - Phone:620-450-1812
Mailing Address - Fax:620-672-7268
Practice Address - Street 1:203 WATSON ST STE 300
Practice Address - Street 2:
Practice Address - City:PRATT
Practice Address - State:KS
Practice Address - Zip Code:67124-3092
Practice Address - Country:US
Practice Address - Phone:620-450-1812
Practice Address - Fax:620-672-7268
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5378096111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner