Provider Demographics
NPI:1497990725
Name:RIDGWAY, LAUREN ALDERDICE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:ALDERDICE
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:ALDERDICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:2405 HARRODSBURG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3329
Practice Address - Country:US
Practice Address - Phone:859-278-9492
Practice Address - Fax:859-469-5461
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1169363A00000X
KYPA1169363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169OtherLC MEDICARE GROUP ID
KY95900478OtherLC MEDICAID GROUP ID PA NUMBER
KY95900478OtherLC MEDICAID GROUP ID PA NUMBER
KYK034240Medicare PIN