Provider Demographics
NPI:1033205281
Name:RIDENOUR, KAREN LYNN (FNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LYNN
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:SUNNY
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP-BC
Mailing Address - Street 1:2828 N STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-4503
Mailing Address - Country:US
Mailing Address - Phone:520-245-6650
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:2828 N STONE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-4503
Practice Address - Country:US
Practice Address - Phone:520-245-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00099474163WE0003X
AZRN128384163WG0000X
WAAP30005175363LF0000X
TX000-00-4767363LF0000X
UT66740254405363LP0808X
AZAP1993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ876196Medicaid
AZ876196Medicaid