Provider Demographics
NPI:1427100353
Name:RIDENOUR, JANELL S (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:S
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5101 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1614
Mailing Address - Country:US
Mailing Address - Phone:816-478-4200
Mailing Address - Fax:816-875-2598
Practice Address - Street 1:3100 BROADWAY BLVD STE 509
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2413
Practice Address - Country:US
Practice Address - Phone:816-531-7373
Practice Address - Fax:816-531-1404
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-01266363A00000X
MO2010002166363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant