Individual
MS. COURTNEY ELIZABETH RIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA05208
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211232802
—
TX
05
—
211232803
—
TX
01
—
831N41
BCBS
TX
Enumeration date
09/07/2007
Last updated
11/08/2012
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