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Individual

STANLEY LEE RIDNER III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
365 STOUT DRIVE, SUITE 160, JOHNSON CITY, TN 37614
(423) 439-4225
(423) 439-4560
Mailing address
501 E BROADWAY, 290, LOUISVILLE, KY 40202-1785
(502) 217-5134
(502) 217-5056

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
23528
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
23528
LICENSE
TN
Enumeration date
01/30/2007
Last updated
01/22/2018
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