| Doctor Name: | DR. KIMBERLY CECIL-RIDDLE |
| NPI Number: | 1215171251 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, APRN, FNP-BC |
| License Number: | 3004526 |
| Business Practice Address: | 2801 Walter Garrett Lane Oak Grove, KY - 42262 |
| Business Phone Number: | 2706405821 |
| Business Fax Number: | 8442705587 |
| Mailing Address: | 2801 Walter Garrett Lane, OAK GROVE |
| State: | KY |
| Postal Code: | 42262 |
| Phone Number: | 2706405821 |
| Fax Number: | 8442705587 |
| NPI Enumeration Date: | 04/21/2009 |
| NPI Last Update Date: | 05/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 3004526 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |