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General NPI Number Information
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NPI Number | 1033909163
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Entity Type | Individual
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Provider Name | TIMOTHY ALAN VANDRUFF II PA
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Gender | Male
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 650 HUEBNER RD
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City | FORT RILEY
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State | KS
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Zip | 66442-4030
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Country | US
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Telephone | 913-242-4477
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Fax |
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Provider Business Mailing Address
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Address Line | 24408 HIGHFLY CIR APT 1
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City | FORT RILEY
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State | KS
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Zip | 66442-4704
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Country | US
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Telephone | 913-242-4477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | KS
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