Provider Demographics
NPI:1619983095
Name:RAGLEY, PHYLLIS A (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:A
Last Name:RAGLEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 W 6TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2249
Mailing Address - Country:US
Mailing Address - Phone:785-843-4202
Mailing Address - Fax:785-843-7656
Practice Address - Street 1:1112 W 6TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2249
Practice Address - Country:US
Practice Address - Phone:785-843-4202
Practice Address - Fax:785-843-7656
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-00165213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS362344OtherHEALTH LINK/PREFERRED CAR
KS165608OtherHEALTH LINK PPO
MO20715012OtherBCBS KC MO
KS607320OtherFIRST GUARD
KS100226840AMedicaid
KS11545OtherPREFERRED HEALTH SYSTEMS
KS2700021OtherUNITED HEALTH CARE
KS006717OtherBCBS KS
KS607320OtherFIRST GUARD
KS362344OtherHEALTH LINK/PREFERRED CAR
MO20715012OtherBCBS KC MO