Individual
JESSICA LEE RIDENOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2548 E KENOSHA ST, BROKEN ARROW, OK 74014-6712
(918) 355-0993
Mailing address
2548 E KENOSHA ST, BROKEN ARROW, OK 74014-6712
(918) 355-0993
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/07/2024
Last updated
10/15/2025
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