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NPI Code Detail

MEDICARE: JESSICA RIDGE NP

MEDICARE: JESSICA RIDGE NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner28177768AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245854801
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA RIDGE NP
Provider Business Mailing Address
First Line : 29943 NETWORK PL
Second Line :
City : CHICAGO
State : IL
Zip : 60673-1299
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8805 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2760
Country : US
Telephone Number : 317-706-7246
Fax Number : 317-706-3417
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2020
Last Update Date : 02/18/2026

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