Provider Demographics
NPI:1194598490
Name:RIDLEN, KELSEY JO (APRN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JO
Last Name:RIDLEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JO
Other - Last Name:ICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2901 TRAILWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8873
Mailing Address - Country:US
Mailing Address - Phone:859-285-4236
Mailing Address - Fax:
Practice Address - Street 1:830 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-8873
Practice Address - Country:US
Practice Address - Phone:593-232-7788
Practice Address - Fax:859-257-8708
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4011310363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health