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NPI Code Detail

MEDICARE: SAMANTHA JO RIDGE FNP-C

MEDICARE: SAMANTHA JO RIDGE FNP-C
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
1363L00000XNurse Practitioner220140OK

General Provider Information

NPI Number : 1659106672
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA JO RIDGE FNP-C
Provider Business Mailing Address
First Line : 1324 W CHEROKEE AVE
Second Line :
City : ENID
State : OK
Zip : 73703-5731
Country : US
Telephone Number : 580-747-9993
Fax Number :
Provider Business Practice Location Address
First Line : 615 E OKLAHOMA AVE STE 202
Second Line :
City : ENID
State : OK
Zip : 73701-5952
Country : US
Telephone Number : 580-233-3230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2024
Last Update Date : 03/16/2026

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Directions to “ SAMANTHA JO RIDGE FNP-C” Practice Location

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