Healthcare Provider Details

I. General information

NPI: 1922771518
Provider Name (Legal Business Name): SHERI LYNN RIDGE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 HIGHWAY 28 STE 100
JASPER TN
37347-3696
US

IV. Provider business mailing address

980 HIGHWAY 28 STE 100
JASPER TN
37347-3696
US

V. Phone/Fax

Practice location:
  • Phone: 423-939-1500
  • Fax:
Mailing address:
  • Phone: 423-939-1500
  • Fax: 423-939-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number30042
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30042
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: