Provider Demographics
NPI:1174082465
Name:RIDENHOUR, SERENA RAE (FNP)
Entity type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:RAE
Last Name:RIDENHOUR
Suffix:
Gender:F
Credentials:FNP
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Other - Credentials:
Mailing Address - Street 1:2431 MOUNT PLEASANT RD W
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:NC
Mailing Address - Zip Code:28124-9566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:525 S TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1839
Practice Address - Country:US
Practice Address - Phone:704-520-0921
Practice Address - Fax:704-943-1571
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5011571363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily