Healthcare Provider Details

I. General information

NPI: 1356652234
Provider Name (Legal Business Name): KRISTEN RITCHEY RD, CD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 01/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 WISHARD BLVD WISHARD PRIMARY CARE CENTER-ADULT MEDICINE CLINIC
INDIANAPOLIS IN
46202-2872
US

IV. Provider business mailing address

1002 WISHARD BLVD WISHARD PRIMARY CARE CENTER-ADULT MEDICINE CLINIC
INDIANAPOLIS IN
46202-2872
US

V. Phone/Fax

Practice location:
  • Phone: 317-656-3947
  • Fax:
Mailing address:
  • Phone: 317-656-3947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number37001989A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: