MEDICARE: MRS. VIRGINIA KATHRYN RIDOUT APN

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	363L00000X	Nurse Practitioner	531734	TX

General Provider Information

NPI Number	:	1568524148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIRGINIA KATHRYN RIDOUT APN

Provider Business Mailing Address
First Line	:	3002 BELMONT CIR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-1411
Country	:	US
Telephone Number	:	512-476-1655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 S I H 35
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-3628
Country	:	US
Telephone Number	:	512-443-9595
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/08/2007

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