Provider Demographics
NPI:1356765945
Name:RITCHIE, KIMBERLY (CNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-2929
Mailing Address - Country:US
Mailing Address - Phone:989-736-9815
Mailing Address - Fax:989-358-3734
Practice Address - Street 1:177 N BARLOW RD
Practice Address - Street 2:
Practice Address - City:HARRISVILLE
Practice Address - State:MI
Practice Address - Zip Code:48740
Practice Address - Country:US
Practice Address - Phone:989-736-8157
Practice Address - Fax:989-358-3762
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704188133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
5729478OtherCIGNA
MI123065OtherMERIDIAN
MI1356765945Medicaid
MI0873010OtherBCBSM
MI1356765945Medicaid