Provider Demographics
NPI:1568462059
Name:RIDENHOUR, KEVIN PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:PATRICK
Last Name:RIDENHOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1000 BRECKENRIDGE ST STE 201
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0876
Practice Address - Country:US
Practice Address - Phone:270-688-3445
Practice Address - Fax:270-688-3444
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600701207RH0003X
KY43969207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100144350Medicaid
P00153508OtherMEDICARE RAILROAD
IN201018430Medicaid
TN3896860Medicaid
IN201018430Medicaid
KY7100144350Medicaid
KYP400032470Medicare PIN
KY7100144350Medicaid