Provider Demographics
NPI:1225250996
Name:WEDGE, KIMBERLY RIDDER (NP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RIDDER
Last Name:WEDGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:RIDDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 GLEASON ST
Mailing Address - Street 2:OCC HEALTH SERVICES
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5223
Mailing Address - Country:US
Mailing Address - Phone:774-552-6102
Mailing Address - Fax:508-771-6445
Practice Address - Street 1:26 GLEASON ST
Practice Address - Street 2:OCC HEALTH SERVICES
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5223
Practice Address - Country:US
Practice Address - Phone:774-552-6102
Practice Address - Fax:508-771-6445
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147033363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health