TARA MICHELLE RIDGEWAY


Address: 2132 E Decatur St, Decatur, IL 62521-3148
Phone: 2173299133

TARA MICHELLE RIDGEWAY (NPI# 1851934988) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1851934988
Entity Type Individual
Full Name TARA MICHELLE RIDGEWAY
Credential APRN
Practice Address 2132 E Decatur St
Decatur
IL 62521-3148
Practice Telephone 2173299133
Mailing Telephone 2173299133
Enumeration Date 2019-10-22
Last Update Date 2019-10-22
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
209019368 IL Physician Assistants & Advanced Practice Nursing Providers
Y 363LP0808X Nurse Practitioner
Specialization: Psych/Mental Health
231483 AZ Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 2132 E DECATUR ST
City DECATUR
State IL
Zip Code 62521-3148

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1154848034 Zack Shaw Physical Therapist 4855-57 East 36, Decatur, IL 62521 2017-08-23
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Taxonomy Information

Taxonomy Code 363LP0808X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Psych/Mental Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1245790914 Faridy Maya Mombeleur Nurse Practitioner 2000 S Fm 51 Ste C, Decatur, TX 76234-3702 2019-03-20
1891204152 Jasmine Keamber Mckinley Nurse Practitioner 1615 Kathy Ln Sw Ste 102, Decatur, AL 35603-1026 2017-09-29
1700305372 Jessica Skarda Nurse Practitioner 1577-1631 Kathy Ln Sw, Decatur, AL 35603 2017-09-14
1306477138 Obiageri Ohayagha Nurse Practitioner 445 Winn Way, Decatur, GA 30030-1707 2020-01-30
1407405905 Erica Y Taylor Nurse Practitioner 120 E Trinity Pl, Decatur, GA 30030-3302 2019-09-06
1205309267 Ashley M Garner Nurse Practitioner 320 E Central Ave, Decatur, IL 62521-4665 2019-01-02
1801379516 Lauren Colegrove Nurse Practitioner 465 Winn Way Ste 221, Decatur, GA 30030-1723 2018-09-09
1619459542 Okechukwu Nnaji Nurse Practitioner 445 Winn Way, Decatur, GA 30030-1707 2018-09-06
1235634635 Olubukola Funmi Olatoto Nurse Practitioner 445 Winn Way, Decatur, GA 30030 2018-03-27
1831693357 Bamidele Odede Nurse Practitioner 445 Winn Way, Decatur, GA 30030 2018-03-20
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Competitor

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City DECATUR
Zip Code 62521

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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