Provider Demographics
NPI:1821547936
Name:RIDDER, JOSHUA D (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:D
Last Name:RIDDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 N MONITOR ST
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1595
Mailing Address - Country:US
Mailing Address - Phone:402-372-6717
Mailing Address - Fax:
Practice Address - Street 1:500 E DECATUR ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1566
Practice Address - Country:US
Practice Address - Phone:402-372-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2064363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant