Provider Demographics
NPI:1700681160
Name:RIDGE, ELAINE
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:RIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:HOOKER
Mailing Address - State:OK
Mailing Address - Zip Code:73945-0001
Mailing Address - Country:US
Mailing Address - Phone:580-461-0015
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1
Practice Address - Street 2:
Practice Address - City:HOOKER
Practice Address - State:OK
Practice Address - Zip Code:73945-0001
Practice Address - Country:US
Practice Address - Phone:580-461-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty