Provider Demographics
NPI:1558144600
Name:RIDDICK, TONYA R
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:R
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 EDWARDS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1262
Mailing Address - Country:US
Mailing Address - Phone:859-663-8832
Mailing Address - Fax:
Practice Address - Street 1:3825 EDWARDS RD STE 103
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1262
Practice Address - Country:US
Practice Address - Phone:859-663-8832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker