Individual
MS. JESSICA L. RIDGELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
Mailing address
5401 OLD COURT RD, ATTN: CREDENTIALING, RANDALLSTOWN, MD 21133-5103
(410) 601-5524
(410) 601-8946
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0003611
MD
363AM0700X
Medical Physician Assistant
C0003611
MD
Other
Enumeration date
10/24/2007
Last updated
10/24/2007
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