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General NPI Number Information
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NPI Number | 1427100353
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Entity Type | Individual
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Provider Name | JANELL S RIDENOUR PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 3100 BROADWAY BLVD STE 509
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City | KANSAS CITY
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State | MO
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Zip | 64111-2413
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Country | US
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Telephone | 816-531-7373
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Fax | 816-531-1404
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Provider Business Mailing Address
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Address Line | 5101 COLLEGE BLVD
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City | LEAWOOD
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State | KS
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Zip | 66211-1614
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Country | US
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Telephone | 816-478-4200
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Fax | 816-875-2598
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15-01266
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2010002166
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License Number State | MO
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