| NPI | 1770839029 |
|---|---|
| Former Name | STACEY LEANN RIDDLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TN APN22481) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000175851) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2025-09-22 |