Provider Demographics
NPI:1639866502
Name:SKITT, RALPH JAY (PA-C)
Entity type:Individual
Prefix:MR
First Name:RALPH
Middle Name:JAY
Last Name:SKITT
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2741
Mailing Address - Country:US
Mailing Address - Phone:636-695-0400
Mailing Address - Fax:816-235-5187
Practice Address - Street 1:9323 PHOENIX VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4281
Practice Address - Country:US
Practice Address - Phone:636-695-0400
Practice Address - Fax:636-916-9456
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2024-09-06
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Provider Licenses
StateLicense IDTaxonomies
MO2024028012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant