Jonathan Ridenour, PA

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

JONATHAN RIDENOUR, PA

Practice address

4801 Troup Hwy Ste 502
Tyler, TX 75703-2357

Phone

(972) 424-9212

Fax

(972) 509-1450

NPI assigned

Mar 11, 2019

Organization subpart

No

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

Authorized official

Name

Michelle Bice

Title

Office Manager

Phone

(903) 630-5788

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonathan Michael Ridenour, PSYD

  • Psychologist
  • Tyler, TX
  • NPI 1760703003
  Medicare reassignment
• Thomas Wilson Renfroe Jr., PSY.D

  • Psychologist
  • Tyler, TX
  • NPI 1659389617
  NPD

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694995200000",
    "number": "1699233403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 TROUP HWY STE 502",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757032357",
            "telephone_number": "903-630-5788",
            "fax_number": "903-630-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 TROUP HWY STE 502",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757032357",
            "telephone_number": "972-424-9212",
            "fax_number": "972-509-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONATHAN RIDENOUR, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-11",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A",
        "authorized_official_last_name": "BICE",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "903-630-5788"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tori Johnston, FNP-C
• Joint Recovery Services LLC
• Jennifer Jolley, LMT
• Mary Claire Jolly, FITTER/DISPENSER
• Jonathan Blau MD PA
• Latorie Jones-Curtis
• Adarsh Samuel Jones, MD
• Ann Hollingsworth Jones, OTR
• Ashley Jones
• Becky S Jones, COTA

• Psychologist in Tyler, TX
• Providers in Tyler, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.