Provider Demographics
NPI:1063308245
Name:RIDER, JOSHUA (APRN)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:RIDER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 KINGS HWY STE 340
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3951
Mailing Address - Country:US
Mailing Address - Phone:318-212-8620
Mailing Address - Fax:318-212-8625
Practice Address - Street 1:2600 KINGS HWY STE 340
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3951
Practice Address - Country:US
Practice Address - Phone:318-212-8620
Practice Address - Fax:318-212-8625
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA241501363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner