Provider Demographics
NPI:1306301429
Name:THOUVENELL, RIKKIE RENEE (MD)
Entity type:Individual
Prefix:
First Name:RIKKIE
Middle Name:RENEE
Last Name:THOUVENELL
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 1:906 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-3041
Mailing Address - Country:US
Mailing Address - Phone:620-308-0860
Mailing Address - Fax:
Practice Address - Street 1:906 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-3041
Practice Address - Country:US
Practice Address - Phone:620-308-0860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-02
Last Update Date:2019-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78885645207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS6780005Medicaid