Healthcare Provider Details

I. General information

NPI: 1124594999
Provider Name (Legal Business Name): RACHEL SKULKETY MERRITT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE RACHEL SKULKETY PA-C

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 N HILLSIDE ST
WICHITA KS
67214-4980
US

IV. Provider business mailing address

835 N HILLSIDE ST
WICHITA KS
67214-4980
US

V. Phone/Fax

Practice location:
  • Phone: 316-685-4395
  • Fax:
Mailing address:
  • Phone: 316-685-4395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-02497
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3270
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: