Provider Demographics
NPI:1699108522
Name:KRITZER, RETTA WEBB (PA)
Entity type:Individual
Prefix:
First Name:RETTA
Middle Name:WEBB
Last Name:KRITZER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RETTA
Other - Middle Name:WILLIAMS
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:153 W 151ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-5348
Mailing Address - Country:US
Mailing Address - Phone:913-764-1125
Mailing Address - Fax:
Practice Address - Street 1:153 W 151ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5348
Practice Address - Country:US
Practice Address - Phone:913-764-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013037124363A00000X
KS15-01631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant