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Individual
NATHANAEL W RIDGE
Active
Individual
NATHANAEL W RIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA, PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
68336662501
UT
363AM0700X
Medical Physician Assistant
Primary
6833666-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780459016
NPPES
UT
Enumeration date
01/13/2011
Last updated
11/24/2023
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