Provider Demographics
NPI:1275810400
Name:WILLIS-RIDGEWAY, JESSICA
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:WILLIS-RIDGEWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WILLIS-RIDGEWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JESSICA PRICE
Mailing Address - Street 1:PO BOX 4021
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-4021
Mailing Address - Country:US
Mailing Address - Phone:601-882-3182
Mailing Address - Fax:
Practice Address - Street 1:105 W WASHINGTON ST STE A-2OFC5
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2416
Practice Address - Country:US
Practice Address - Phone:601-473-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174H00000XOther Service ProvidersHealth Educator
No253Z00000XAgenciesIn Home Supportive Care
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program