Individual
TYCE MCKEYAN RIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(606) 422-4204
Mailing address
310 S HANCOCK ST UNIT 309, LOUISVILLE, KY 40202-4102
(606) 422-4204
Taxonomy
Speciality
Code
Description
License number
State
261QS1000X
Student Health Clinic/Center
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/20/2023
Last updated
04/10/2026
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