Riddleberger, Kevin W

Riddleberger, Kevin W is an individual health care provider with primary practice located at 1551 Professional Ln Suite 200, Longmont CO 80501-6972. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Riddleberger, Kevin W can be contacted via phone (303) 772-1600.

Contact Information

Primary practice address
1551 Professional Ln Suite 200 Longmont CO 80501-6972
Phone: (303) 772-1600
Fax: (303) 772-9317
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 1801 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 1801 Colorado

Profile Details

NPI number 1396745683
LBN Legal business name Riddleberger, Kevin W
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 28th, 2005
Last updated Nov 9th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396745683 NPPES
Colorado MEDICAID 54570867

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