Kevin W Riddleberger, P.A.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1801 Issued in CO

Practice address

1551 Professional LN
Suite 200
Longmont, CO 80501-6972

Phone

(303) 772-1600

Fax

(303) 772-9317

NPI assigned

Jul 28, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1122508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289260800000",
    "number": "1396745683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 PROFESSIONAL LN",
            "address_2": "SUITE 200",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016972",
            "telephone_number": "303-772-1600",
            "fax_number": "303-772-9317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 PROFESSIONAL LN",
            "address_2": "SUITE 200",
            "city": "LONGMONT",
            "state": "CO",
            "postal_code": "805016972",
            "telephone_number": "303-772-1600",
            "fax_number": "303-772-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDLEBERGER",
        "first_name": "KEVIN",
        "middle_name": "W",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-28",
        "last_updated": "2010-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "1801",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "1801",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "54570867",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maclovia Lois Richardson
• Mary Lynn Richardson, RPT
• Karyssa Richman, LMT
• Katie Ricketts, CF SLP
• Jeremy Riddell-Kaufman, LPC, MA
• David Neale Ridinger, L.P.C.
• Kevin Riedel, PT
• Kaden Joseph Riekenberg, DC
• Cydney Renee Riggio, CNT
• Jason Riley, C.P.

• Surgical Physician Assistant in Longmont, CO
• Providers in Longmont, CO by specialty
• Surgical Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.