Individual
RYAN BLAKE PRIDEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
5700 MESA GRANDE DR, LAS CRUCES, NM 88011-6017
(423) 312-1031
Mailing address
3402 BIXLER DR APT 2202, LAS CRUCES, NM 88012-5114
(423) 312-1031
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-2024-0006
NM
2255A2300X
Athletic Trainer
AT9424
TX
Other
Enumeration date
06/27/2023
Last updated
06/10/2025
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