Provider Demographics
NPI:1891538088
Name:RITCHIE, KERENSA JOY (CNM)
Entity type:Individual
Prefix:
First Name:KERENSA
Middle Name:JOY
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 CEDAR LINKS DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-5002
Mailing Address - Country:US
Mailing Address - Phone:541-778-2222
Mailing Address - Fax:
Practice Address - Street 1:750 TWIN CREEKS XING APT A
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-8656
Practice Address - Country:US
Practice Address - Phone:541-778-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10026296367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty