Provider Demographics
NPI:1710458328
Name:RIDLEY JONES, JESSICA LUCRETIA (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LUCRETIA
Last Name:RIDLEY JONES
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:RIDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-7224
Mailing Address - Fax:336-718-7598
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-7224
Practice Address - Fax:336-718-7598
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011582363L00000X
NCRIDL-19Q272363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner