Active NPI
Jordan Riddle, PA-C
- Physician Assistant
- Wilson, NC
National Provider Identifier
1750111993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0010-15079
- Practice address
- 1801 Glendale Dr SW
Wilson, NC 27893-4401 - Phone
- (252) 237-3141
- Fax
- (252) 220-9641
- NPI assigned
- Aug 2, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-15079 | NC | Primary |
Addresses
Primary practice location
1801 Glendale Dr SW
Wilson, NC 27893-4401
Mailing address
1801 Glendale Dr SW
Wilson, NC 27893-4499
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
123 Laurel Dr
Pikeville, NC 27863-8395
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Wilson | Current | Accepting new patients | |
| County of Wilson | Past | Accepting new patients |
Locations
1801 Glendale Dr SW
Wilson, NC 27893
Phone (252) 237-3141
Organizations & group practices 2
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.
-
dba Wilson Co. Dept. of Public Health
- Community Health Clinic/Center
- Wilson, NC
- NPI 1467507640
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1722556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778630400000",
"number": "1750111993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 GLENDALE DR SW",
"city": "WILSON",
"state": "NC",
"postal_code": "278934499",
"fax_number": "252-220-9641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 GLENDALE DR SW",
"city": "WILSON",
"state": "NC",
"postal_code": "278934401",
"telephone_number": "252-237-3141",
"fax_number": "252-220-9641"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDDLE",
"first_name": "JORDAN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-08-02",
"last_updated": "2026-05-13",
"certification_date": "2026-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "0010-15079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilson, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.