Provider Demographics
NPI:1881791242
Name:RULEN-RIDDLE, JESSICA ERIN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
Last Name:RULEN-RIDDLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 THIRD AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1453
Mailing Address - Country:US
Mailing Address - Phone:304-526-7246
Mailing Address - Fax:304-526-1951
Practice Address - Street 1:2860 THIRD AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1453
Practice Address - Country:US
Practice Address - Phone:304-526-7246
Practice Address - Fax:304-526-1951
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV01230363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001892682OtherMSBCBS
WVP00363169OtherRR MEDICARE
WV1072150OtherBRICKSTREET INDIVIDUAL
WVP00363169OtherRR MEDICARE
WV9359501Medicare PIN
WVDE2690OtherRR MEDICARE
WV0061620000Medicaid
WVPA27521Medicare PIN
WV203735494OtherTRICARE
WVP00363169OtherRR MEDICARE
WV20373549400OtherBRICKSTREET
WV20373549400OtherWORKERS COMP