MEDICARE: MS. AMANDA LEIGH RIDENHOUR MSN, MED, RD, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD002434	GA
2	133V00000X	Registered Dietitian	L002333	NC
3	163WD0400X	Diabetes Educator Registered Nurse	292466	NC
4	363LF0000X	Family Nurse Practitioner	5014253	NC

General Provider Information

NPI Number	:	1558540518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMANDA LEIGH RIDENHOUR MSN, MED, RD, NP-C

Provider Business Mailing Address
First Line	:	30 DUKE MEDICINE CIR # 1A
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-3000
Country	:	US
Telephone Number	:	919-668-5360
Fax Number	:	919-684-5743

Provider Business Practice Location Address
First Line	:	30 DUKE MEDICINE CIR # 1A
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27710-3000
Country	:	US
Telephone Number	:	919-668-5360
Fax Number	:	919-684-5743

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	07/01/2025

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