Provider Demographics
NPI:1174023683
Name:RIDLEY, MILAKEITHA R (LVN)
Entity Type:Individual
Prefix:
First Name:MILAKEITHA
Middle Name:R
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16302 EL CAMINO REAL APT 2208
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-5211
Mailing Address - Country:US
Mailing Address - Phone:281-571-1241
Mailing Address - Fax:
Practice Address - Street 1:16302 EL CAMINO REAL APT 2208
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-5211
Practice Address - Country:US
Practice Address - Phone:281-571-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319729164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse