Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Desyrae Eliza Ridenour

Individual provider Physician Assistant · NPI 1891557575

Desyrae Eliza Ridenour is a Physician Assistant in Springfield, Missouri. Qualified in 2023, 3 years ago. Practices with Lester E Cox Medical Centers, a 243-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
3
Licensed in
MO
In the registry since
2024
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

960 E Walnut Lawn St Ste 201
Springfield, MO 65807-7865
Phone: (417) 269-4450
Fax: (417) 269-4470
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 2024003095 (MO)

Record details

NPI number1891557575
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJanuary 29, 2024
Last updated in NPPESApril 30, 2024
Certification dateApril 30, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Lester E Cox Medical Centers — 243 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Springfield