Individual
MISS MIKALA RIDDLESWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
2151 CENTURY LN, JOHNSON CITY, TN 37604-4469
(423) 926-2500
(423) 926-5999
Mailing address
365 STOUT DRIVE BOX 70403, JOHNSON CITY, TN 37614-1703
(423) 439-4515
(423) 439-4060
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1858
TN
363AM0700X
Medical Physician Assistant
004986
GA
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
03/15/2007
Last updated
07/08/2016
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