Provider Demographics
NPI:1275040669
Name:RIDENOUR, CHELSEY RENEE
Entity Type:Individual
Prefix:
First Name:CHELSEY
Middle Name:RENEE
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 WINDMILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36352-8375
Mailing Address - Country:US
Mailing Address - Phone:989-763-3986
Mailing Address - Fax:
Practice Address - Street 1:881 WINDMILL RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:AL
Practice Address - Zip Code:36352-8375
Practice Address - Country:US
Practice Address - Phone:989-763-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-07
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-189905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily