Provider Demographics
NPI:1427066075
Name:RITCHIE, JACQUELYN A (PA)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:A
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE104
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1231
Mailing Address - Country:US
Mailing Address - Phone:716-677-6736
Mailing Address - Fax:716-677-6144
Practice Address - Street 1:3055 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE104
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1231
Practice Address - Country:US
Practice Address - Phone:716-677-6736
Practice Address - Fax:716-677-6144
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005824-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027303901OtherUNIVERA
NY000570125008OtherHEALTH NOW
NY9513005OtherIHA
NY161000580OtherNOVA
NY00027303901OtherUNIVERA
NY161000580OtherNOVA