Provider Demographics
NPI:1750730578
Name:RIDDLE, STEPHANIE SUTTON (NP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SUTTON
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 JUDY LN
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-4461
Mailing Address - Country:US
Mailing Address - Phone:478-737-2395
Mailing Address - Fax:
Practice Address - Street 1:316 JUDY LN
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-4461
Practice Address - Country:US
Practice Address - Phone:478-737-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN216373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily