Provider Demographics
NPI:1376691550
Name:RIDYARD, KRISTINE POET (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:POET
Last Name:RIDYARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2573
Mailing Address - Country:US
Mailing Address - Phone:860-429-5443
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CT STUDENT HEALTH SERVICES
Practice Address - Street 2:234 GLENBROOK DRIVE UNIT 2011
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06269-0001
Practice Address - Country:US
Practice Address - Phone:860-487-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001823363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health