Provider Demographics
NPI:1619585742
Name:RIDDLE, JESSIE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:LYNN
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1334 MELINDA FERRY RD
Mailing Address - Street 2:
Mailing Address - City:BULLS GAP
Mailing Address - State:TN
Mailing Address - Zip Code:37711-4901
Mailing Address - Country:US
Mailing Address - Phone:423-307-6726
Mailing Address - Fax:
Practice Address - Street 1:1334 MELINDA FERRY RD
Practice Address - Street 2:
Practice Address - City:BULLS GAP
Practice Address - State:TN
Practice Address - Zip Code:37711-4901
Practice Address - Country:US
Practice Address - Phone:423-307-6726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN235450163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse