Provider Demographics
NPI:1952634297
Name:RIDDLE, RYANE MERIDYTH (APRN)
Entity Type:Individual
Prefix:
First Name:RYANE
Middle Name:MERIDYTH
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8921 E 81ST ST
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-1506
Mailing Address - Country:US
Mailing Address - Phone:913-205-9013
Mailing Address - Fax:913-674-5563
Practice Address - Street 1:2790 CLAY EDWARDS DR STE 1250
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3260
Practice Address - Country:US
Practice Address - Phone:816-421-3700
Practice Address - Fax:816-421-1654
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007028742363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01045246OtherRAILROAD MEDICARE
KS200640620AMedicaid
MO1952634297Medicaid
MO1952634297Medicaid
KSKA1093007Medicare PIN