Provider Demographics
NPI:1780978783
Name:RIDGEWAY, JENNIFFER (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFFER
Middle Name:
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:NEWBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26410-0242
Mailing Address - Country:US
Mailing Address - Phone:304-940-9960
Mailing Address - Fax:
Practice Address - Street 1:17548 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-9797
Practice Address - Country:US
Practice Address - Phone:304-441-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2021-07-19
Deactivation Date:2021-06-30
Deactivation Code:
Reactivation Date:2021-07-15
Provider Licenses
StateLicense IDTaxonomies
WV110019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily