Provider Demographics
NPI:1306076054
Name:RIDGLEY, JESSICA A (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:RIDGLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10107 RIDGEGATE PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5641
Mailing Address - Country:US
Mailing Address - Phone:037-925-2003
Mailing Address - Fax:303-792-5201
Practice Address - Street 1:10107 RIDGEGATE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5641
Practice Address - Country:US
Practice Address - Phone:303-792-5200
Practice Address - Fax:303-792-5201
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241688207R00000X
MO2013018505208M00000X
CODR.0061442207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO132680461Medicare PIN