Provider Demographics
NPI:1720410327
Name:RIDLEY, MARTHA Y (APRN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:Y
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:RIDLEY
Other - Last Name:DEMPEWOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1305 N ELM ST
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2783
Mailing Address - Country:US
Mailing Address - Phone:270-631-2412
Mailing Address - Fax:270-827-7475
Practice Address - Street 1:1413 N ELM ST STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2767
Practice Address - Country:US
Practice Address - Phone:270-827-8662
Practice Address - Fax:270-826-8220
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1117672163W00000X
KY3008270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100258970Medicaid
KYK119680Medicare PIN