Provider Demographics
NPI:1033371307
Name:RYDER, JESSICA CHLOE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CHLOE
Last Name:RYDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 MONTGOMERY BLVD NE STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1246
Mailing Address - Country:US
Mailing Address - Phone:505-727-7833
Mailing Address - Fax:
Practice Address - Street 1:4705 MONTGOMERY BLVD NE STE 102
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1246
Practice Address - Country:US
Practice Address - Phone:505-727-7833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2008-022207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology