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General NPI Number Information
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NPI Number | 1437683174
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Entity Type | Individual
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Provider Name | DR. TERA RIDDICK
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Gender | Female
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 107 XAVIER ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-3618
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Country | US
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Telephone | 601-310-9785
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Fax |
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Provider Business Mailing Address
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Address Line | 107 XAVIER ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-3618
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Country | US
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Telephone | 601-310-9785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP136023
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11016385
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024182319
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 902065
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License Number State | MS
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 403905
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License Number State | NY
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95008223
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12410130-4405
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License Number State | UT
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Taxonomy #8
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704337467
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License Number State | MI
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Taxonomy #9
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 847297
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License Number State | NV
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Taxonomy #10
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 277.001649
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License Number State | IL
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Taxonomy #11
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61207763
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License Number State | WA
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Taxonomy #12
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 71519
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License Number State | ID
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Taxonomy #13
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3017193
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License Number State | KY
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Taxonomy #14
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 64961
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License Number State | NM
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Taxonomy #15
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP136023
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License Number State | TX
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