Provider Demographics
NPI:1336617802
Name:RIDDLEBARGER, BRIANNA
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:
Last Name:RIDDLEBARGER
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 1:3421 STORY RD W
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3571
Mailing Address - Country:US
Mailing Address - Phone:888-544-0470
Mailing Address - Fax:888-544-0470
Practice Address - Street 1:3421 STORY RD W
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3571
Practice Address - Country:US
Practice Address - Phone:888-544-0470
Practice Address - Fax:888-544-0470
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA575982084P0800X
CA57598363A00000X
TXPA157652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty