Provider Demographics
NPI:1023457108
Name:MICHELS, RYAN CHRISTOPHER (PA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:MICHELS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTT CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67871
Mailing Address - Country:US
Mailing Address - Phone:620-872-2187
Mailing Address - Fax:620-872-7193
Practice Address - Street 1:201 ALBERT AVE
Practice Address - Street 2:
Practice Address - City:SCOTT CITY
Practice Address - State:KS
Practice Address - Zip Code:67871
Practice Address - Country:US
Practice Address - Phone:620-872-2187
Practice Address - Fax:620-872-7193
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501616363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201157670AMedicaid