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NPI Code Detail

MEDICARE: KRISTI JEANETTE RIDDLE FNP

MEDICARE: KRISTI JEANETTE RIDDLE FNP
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 Practitioner11216TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14204304OTHERTNBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
34156897OTHERTNBLUE CROSS

General Provider Information

NPI Number : 1568452837
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTI JEANETTE RIDDLE FNP
Provider Business Mailing Address
First Line : 700 W FOREST AVE
Second Line : SUITE 200
City : JACKSON
State : TN
Zip : 38301-3937
Country : US
Telephone Number : 731-541-9490
Fax Number : 731-541-9485
Provider Business Practice Location Address
First Line : 700 W FOREST AVE
Second Line : SUITE 200
City : JACKSON
State : TN
Zip : 38301-3937
Country : US
Telephone Number : 731-541-9490
Fax Number : 731-541-9485
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 07/03/2013

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Directions to “ KRISTI JEANETTE RIDDLE FNP” Practice Location

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