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NPI Code Detail

MEDICARE: ELIZABETH A RIDDLE CFNP

MEDICARE: ELIZABETH A RIDDLE CFNP
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 Practitioner10751TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13380640OTHERTNMEDICARE GROUP

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720075633
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH A RIDDLE CFNP
Provider Business Mailing Address
First Line : 205 HOSPITAL DR
Second Line : SUITE A
City : MC KENZIE
State : TN
Zip : 38201-1649
Country : US
Telephone Number : 731-352-7907
Fax Number : 731-352-4459
Provider Business Practice Location Address
First Line : 136 S WILSON ST
Second Line :
City : DRESDEN
State : TN
Zip : 38225-1133
Country : US
Telephone Number : 731-352-7907
Fax Number : 731-364-4900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 10/05/2022

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Directions to “ ELIZABETH A RIDDLE CFNP” Practice Location

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