Provider Demographics
NPI:1861786097
Name:RIDGLEY, ERICA K (CM)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:K
Last Name:RIDGLEY
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 E DEWEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-4203
Mailing Address - Country:US
Mailing Address - Phone:918-949-8867
Mailing Address - Fax:
Practice Address - Street 1:121 E DEWEY AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4203
Practice Address - Country:US
Practice Address - Phone:918-224-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23114171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator