Provider Demographics
NPI:1275054744
Name:PRIDGEN, ALESHA PATTON
Entity Type:Individual
Prefix:
First Name:ALESHA
Middle Name:PATTON
Last Name:PRIDGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1367 S RAILROAD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1461
Mailing Address - Country:US
Mailing Address - Phone:850-676-4273
Mailing Address - Fax:850-676-4274
Practice Address - Street 1:1367 S RAILROAD AVE STE A
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1461
Practice Address - Country:US
Practice Address - Phone:850-676-4273
Practice Address - Fax:850-676-4274
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234778376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020758200Medicaid