Individual
DR. KIMBERLY CECIL-RIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DNP, APRN, FNP-BC
Contact information
Practice address
2801 WALTER GARRETT LANE, OAK GROVE, KY 42262
(270) 640-5821
(844) 270-5587
Mailing address
2801 WALTER GARRETT LANE, OAK GROVE, KY 42262
(270) 640-5821
(844) 270-5587
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3004526
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
474415234
TRICARE
—
05
—
7100395690
—
KY
01
—
K202700
MEDICARE: INDIVIDUAL
KY
01
—
K202701
MEDICARE GROUP (ST. MICHAEL'S)
KY
05
—
Q020269
—
TN
Enumeration date
04/21/2009
Last updated
07/19/2016
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