Provider Demographics
NPI:1124594999
Name:MERRITT, RACHEL SKULKETY (PA-C)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:SKULKETY
Last Name:MERRITT
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:RACHEL
Other - Last Name:SKULKETY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:835 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4980
Mailing Address - Country:US
Mailing Address - Phone:316-685-4395
Mailing Address - Fax:
Practice Address - Street 1:835 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4980
Practice Address - Country:US
Practice Address - Phone:316-685-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS15-02497363A00000X
SC3270363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program