Provider Demographics
NPI:1245047190
Name:RIDGELINE TERRACE PSYCHIATRY & WELLNESS LLC
Entity type:Organization
Organization Name:RIDGELINE TERRACE PSYCHIATRY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:435-299-7083
Mailing Address - Street 1:250 N FAIRGROUNDS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4201
Mailing Address - Country:US
Mailing Address - Phone:435-299-7083
Mailing Address - Fax:435-637-2176
Practice Address - Street 1:250 N FAIRGROUNDS RD STE 3
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4201
Practice Address - Country:US
Practice Address - Phone:435-299-7083
Practice Address - Fax:435-637-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-13
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty