Timothy Rafferty, PA-C

Individual provider Active NPI Medical Physician Assistant · McConnell Afb, KS

NPI 1750799359 · NPPES record last updated Aug 26, 2025

Key facts

NPI
1750799359
Entity type
Individual (NPI type 1)
Primary specialty
Medical Physician Assistant 363AM0700X
License
237167 (NC)
Practice address
57950 Leavenworth St
McConnell Afb, KS 67221-3505
Phone
(316) 759-2057
NPI assigned
Jul 27, 2014
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
237167NCMDMedical Physician Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Medical Physician Assistant 363AM0700X 237167 NC Yes

Addresses

Primary practice location

57950 Leavenworth St
McConnell Afb, KS 67221-3505

Mailing address

57950 Leavenworth St
McConnell Afb, KS 67221-3505

Other providers in McConnell Afb, KS

All providers in McConnell Afb, KS · Medical Physician Assistant in Kansas

Sources for this page

Verify at the official NPI Registry.