Leslie Riddle

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

277694-4405 Issued in UT

Practice address

1231 Camelot Dr
Provo, UT 84601-1454

Phone

(801) 691-9875

NPI assigned

Apr 16, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Interoperability endpoints

• Direct secure messaging: leslie.riddle.1@17226.direct.athenahealth.com

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

{
    "created_epoch": "1618531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703808000000",
    "number": "1639750169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1840 S 1300 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841053617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1231 CAMELOT DR",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011454",
            "telephone_number": "801-691-9875"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1840 S 1300 E",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841053617",
            "country_code": "US",
            "telephone_number": "801-832-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDDLE",
        "first_name": "LESLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-16",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "277694-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brent Mitchell Richey, LCSW
• Cheysi Richey
• Jordan McKay Richey
• Mark A. Richey, MD
• Christopher Ricks, MD
• Seth Allred Riddle, M.D.
• Aaron Foster Ridenour
• Mary Jean Ridges, LCSW
• Teri J Riding, ATC
• Mackenzie Ridley, PA

• Family Nurse Practitioner in Provo, UT
• Providers in Provo, UT by specialty
• Family Nurse Practitioner in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2023; 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.