Individual
MRS. KIA B RIDDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3432 HOLLAND RD, VIRGINIA BEACH, VA 23452-4846
(757) 468-1855
Mailing address
5000 COX RD STE 124, GLEN ALLEN, VA 23060-9263
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0110002819
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05501
GROUP PTAN#
VA
01
—
MC10656
MEDICARE PTAN
VA
Enumeration date
07/09/2008
Last updated
07/12/2022
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