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).
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 |
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 |
Street Address |
2132 E DECATUR ST |
City | DECATUR |
State | IL |
Zip Code | 62521-3148 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
Find all providers in zip 62521 |
Taxonomy Code | 363LP0808X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Psych/Mental Health |
Definition to come... |
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 |
Find all providers in DECATUR |
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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.