Provider Demographics
NPI:1316316177
Name:RICUMSTRICT, TEKIA ELAINE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TEKIA
Middle Name:ELAINE
Last Name:RICUMSTRICT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TEKIA
Other - Middle Name:ELAINE
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:700 FULLER AVENUE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-632-7186
Mailing Address - Fax:
Practice Address - Street 1:700 FULLER AVENUE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:616-632-7186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007465363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant