Provider Demographics
NPI:1417843046
Name:RIDOUT, KAITLIN (ARPN)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:RIDOUT
Suffix:
Gender:F
Credentials:ARPN
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:REISIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3815 N 158TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-2849
Mailing Address - Country:US
Mailing Address - Phone:303-803-8520
Mailing Address - Fax:
Practice Address - Street 1:16901 LAKESIDE HILLS CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2318
Practice Address - Country:US
Practice Address - Phone:303-803-8520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program