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Individual
KAORU JOAN PRIDGEN
Active
Individual
KAORU JOAN PRIDGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25856
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
258562
—
SC
Enumeration date
01/25/2006
Last updated
01/18/2022
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