Provider Demographics
NPI:1609494814
Name:RIDENOUR, AMY SUE (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 N DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-9525
Mailing Address - Country:US
Mailing Address - Phone:417-350-9327
Mailing Address - Fax:
Practice Address - Street 1:429 N DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-9525
Practice Address - Country:US
Practice Address - Phone:417-350-9327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020016165363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily