Provider Demographics
NPI:1134692304
Name:RIDDICK, PATRICIA FERNANDEZ
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:FERNANDEZ
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 MYERS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:SC
Mailing Address - Zip Code:29061-9764
Mailing Address - Country:US
Mailing Address - Phone:915-526-3958
Mailing Address - Fax:
Practice Address - Street 1:2000 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1002
Practice Address - Country:US
Practice Address - Phone:803-576-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC244665163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse