Provider Demographics
NPI:1366202194
Name:RITTER, TIFFANY LYNN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNN
Last Name:RITTER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:LYNN
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5501 W PATRIOT ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57107-0477
Mailing Address - Country:US
Mailing Address - Phone:605-254-5176
Mailing Address - Fax:
Practice Address - Street 1:5100 E ROSA PARKS PL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-3091
Practice Address - Country:US
Practice Address - Phone:605-306-3240
Practice Address - Fax:605-271-3376
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR050559163W00000X
SDCP003284363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse