Provider Demographics
NPI:1477229458
Name:RIPLEY, REBECCA MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:MARIE
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 KIDWELL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1720
Mailing Address - Country:US
Mailing Address - Phone:423-426-4286
Mailing Address - Fax:
Practice Address - Street 1:1540 KIDWELL RIDGE RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1720
Practice Address - Country:US
Practice Address - Phone:423-426-4286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000027389367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ070666Medicaid