Healthcare Provider Details

I. General information

NPI: 1619082815
Provider Name (Legal Business Name): MATTHEW C RIDDER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S GRAND AVE
SAINT MARYS KS
66536-1637
US

IV. Provider business mailing address

1306 STATE ST
AUGUSTA KS
67010-1126
US

V. Phone/Fax

Practice location:
  • Phone: 785-437-3734
  • Fax: 785-437-6186
Mailing address:
  • Phone: 316-775-9191
  • Fax: 316-775-0348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number44629
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number44629
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: