Provider Demographics
NPI:1548071814
Name:VANDE KERKHOFF, NICHOLAS RYAN (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RYAN
Last Name:VANDE KERKHOFF
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:VANDE KERKHOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:5581 NW SUNRISE MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1284
Mailing Address - Country:US
Mailing Address - Phone:248-825-7765
Mailing Address - Fax:
Practice Address - Street 1:4401 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3220
Practice Address - Country:US
Practice Address - Phone:248-825-7765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant