Healthcare Provider Details

I. General information

NPI: 1972879203
Provider Name (Legal Business Name): PATRICIA CHARLENE RIDINGS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 BARKER DRIVE
OSWEGO KS
67356-9034
US

IV. Provider business mailing address

805 BARKER DR
OSWEGO KS
67356-9034
US

V. Phone/Fax

Practice location:
  • Phone: 620-795-2525
  • Fax:
Mailing address:
  • Phone: 620-795-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75537-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: