Provider Demographics
NPI:1821730649
Name:RIDGELL, CASEY BERRY (APRN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:BERRY
Last Name:RIDGELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:MIRANDA
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:378 FANNIE BLACK RD
Mailing Address - Street 2:
Mailing Address - City:PROSPERITY
Mailing Address - State:SC
Mailing Address - Zip Code:29127-6943
Mailing Address - Country:US
Mailing Address - Phone:803-603-7676
Mailing Address - Fax:
Practice Address - Street 1:460 CLEMSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7925
Practice Address - Country:US
Practice Address - Phone:803-438-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25903363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology