Provider Demographics
NPI:1508948852
Name:RIDGLEY, KIRA LEIGH (PA)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:LEIGH
Last Name:RIDGLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 NORTHWEST BLVD.
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538
Mailing Address - Country:US
Mailing Address - Phone:337-907-6338
Mailing Address - Fax:
Practice Address - Street 1:1105 NORTHWEST BLVD.
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538
Practice Address - Country:US
Practice Address - Phone:337-907-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1312291Medicaid
LA1508948852OtherNPI
LAQ15418Medicare UPIN
LA1508948852OtherNPI
LA249098YH4EMedicare PIN