Healthcare Provider Details

I. General information

NPI: 1265012561
Provider Name (Legal Business Name): JESSICA RYNDERS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57950 LEAVENWORTH ST BLDG 250
MCCONNELL AFB KS
67221-3505
US

IV. Provider business mailing address

57950 LEAVENWORTH ST BLDG 250
MCCONNELL AFB KS
67221-3505
US

V. Phone/Fax

Practice location:
  • Phone: 316-759-5050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: