Provider Demographics
NPI:1972201697
Name:JANTSCH, RYAN ELIZABETH (PA STUDENT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ELIZABETH
Last Name:JANTSCH
Suffix:
Gender:F
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13019 EBY LN
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-4607
Mailing Address - Country:US
Mailing Address - Phone:913-634-3353
Mailing Address - Fax:
Practice Address - Street 1:1301 W 12TH AVE STE 110
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2587
Practice Address - Country:US
Practice Address - Phone:620-343-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS15-03010363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program