Jentry Danielle Riddle, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA05748 Issued in TX

Practice address

4204 East Stan Schleuter Loop
Killeen, TX 76542-8352

Phone

(254) 690-2800

Fax

(254) 690-5401

NPI assigned

Jul 7, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Jentry Danielle Andrews Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Allergy and Asthma Clinic of Central Texas, PA

  • Allergy & Immunology Physician
  • Round Rock, TX
  • NPI 1831294800
  Medicare reassignment
• Round Rock Mental Health PA

  dba Central Texas Mental Health

  • Psychiatry Physician
  • Round Rock, TX
  • NPI 1538338306

  Medical

  NPD (past)
• Atlantic Professional Services of New Jersey, P.a.

  • Physician Assistant
  • Stratford, NJ
  • NPI 1932145182
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245024000000",
    "number": "1003849837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 SAM BASS ROAD",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786814137",
            "telephone_number": "512-388-1861",
            "fax_number": "512-388-0373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4204 EAST STAN SCHLEUTER LOOP",
            "city": "KILLEEN",
            "state": "TX",
            "postal_code": "765428352",
            "telephone_number": "254-690-2800",
            "fax_number": "254-690-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDLE",
        "first_name": "JENTRY",
        "middle_name": "DANIELLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2009-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "MP00154600",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA05748",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA05748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1991747-01",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1991747-02",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENTRY",
            "last_name": "ANDREWS",
            "middle_name": "DANIELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nichole Richardson
• Shelby Richardson
• Jade Richmond, RN
• Samantha Richter
• Kaitlyn Ricke, OTR, MOT
• Christine Andrea Rincon, RN
• Amanda Ring
• Adamari Rios Salgado
• Denise Ripley
• Leeann Ripstra, LPC

• Medical Physician Assistant in Killeen, TX
• Providers in Killeen, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.