Individual
KIRBY RYAN LEIGHTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7220 MOUNT RUSHMORE RD, RAPID CITY, SD 57702
(605) 341-1414
Mailing address
7220 MOUNT RUSHMORE RD, RAPID CITY, SD 57702-8754
(605) 341-1414
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0624
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6828030
—
SD
01
—
P00352296
MEDICARE RAILROAD PTAN
—
Enumeration date
08/05/2006
Last updated
10/30/2019
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