Provider Demographics
NPI:1861516163
Name:RIDDLE, JESSICA L (BA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:L
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 6 BOX 1754
Mailing Address - Street 2:WEST HWY. 90
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-3507
Mailing Address - Country:US
Mailing Address - Phone:606-340-9008
Mailing Address - Fax:606-340-0560
Practice Address - Street 1:RR 6 BOX 1754
Practice Address - Street 2:WEST HWY. 90
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-3507
Practice Address - Country:US
Practice Address - Phone:606-340-9008
Practice Address - Fax:606-340-0560
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator