Provider Demographics
NPI:1497837959
Name:ARIDGE, DELLA LOUISE (RN, MSN, NP)
Entity Type:Individual
Prefix:MISS
First Name:DELLA
Middle Name:LOUISE
Last Name:ARIDGE
Suffix:
Gender:F
Credentials:RN, MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 KENNERLY RD
Mailing Address - Street 2:SUITE 330A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2141
Mailing Address - Country:US
Mailing Address - Phone:314-543-5963
Mailing Address - Fax:314-525-4323
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:SUITE 330 A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-543-5963
Practice Address - Fax:314-525-4323
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO063677163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO416213OtherHEALTHLINK
MO13886OtherANTHEM BLUE CROSS BLUE SH
MO425358702Medicaid
MO425358702Medicaid
MO835971104Medicare PIN