Healthcare Provider Details

I. General information

NPI: 1790417681
Provider Name (Legal Business Name): VIRIDIANA MADRID RIDDLE DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E 5TH ST
SCOTT CITY KS
67871-1601
US

IV. Provider business mailing address

212 E 5TH ST
SCOTT CITY KS
67871-1601
US

V. Phone/Fax

Practice location:
  • Phone: 620-214-2303
  • Fax:
Mailing address:
  • Phone: 620-872-3706
  • Fax: 833-440-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81332-022
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: