Provider Demographics
NPI:1437900602
Name:CONDELL RYDER, KELLY JEAN (LM, CPM)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:CONDELL RYDER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 NW 41ST CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4517
Mailing Address - Country:US
Mailing Address - Phone:954-347-8644
Mailing Address - Fax:
Practice Address - Street 1:1301 NW 41ST CT
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-4517
Practice Address - Country:US
Practice Address - Phone:954-347-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW463176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife