Provider Demographics
NPI:1568452837
Name:RIDDLE, KRISTI JEANETTE (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:JEANETTE
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W FOREST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3937
Mailing Address - Country:US
Mailing Address - Phone:731-541-9490
Mailing Address - Fax:731-541-9485
Practice Address - Street 1:700 W FOREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3937
Practice Address - Country:US
Practice Address - Phone:731-541-9490
Practice Address - Fax:731-541-9485
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4204304OtherBCBS
TN36404411Medicaid
TN4156897OtherBLUE CROSS
TN36404411Medicare PIN
TNQ43462Medicare UPIN
TN36404412Medicare PIN