Provider Demographics
NPI:1104919505
Name:PRITCHETT, ANGELIQUE' C (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELIQUE'
Middle Name:C
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1331
Mailing Address - Country:US
Mailing Address - Phone:913-469-0503
Mailing Address - Fax:913-469-5267
Practice Address - Street 1:12210 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 135
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2812
Practice Address - Country:US
Practice Address - Phone:913-438-6700
Practice Address - Fax:913-428-1500
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430862207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
34559018OtherBCBS KANSAS CITY
KS200270130AMedicaid
H24890Medicare UPIN
M54D474Medicare ID - Type UnspecifiedKANSAS CITY
KS200270130AMedicaid