| Ridgewood Clinics Pa | |
|
1059 Ridgewood Clinic Jackson MS 39211 | |
| (601) 957-3211 | |
| (601) 957-9753 |
| Full Name | Ridgewood Clinics Pa |
|---|---|
| Speciality | Counselor |
| Location | 1059 Ridgewood Clinic, Jackson, Mississippi |
| Authorized Official Name and Position | Krishan K. Gupta (PHYSICIAN) |
| Authorized Official Contact | 6019573211 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ridgewood Clinics Pa 1059 Ridgewood Clinic Jackson MS 39211 Ph: (601) 957-3211 | Ridgewood Clinics Pa 1059 Ridgewood Clinic Jackson MS 39211 Ph: (601) 957-3211 |
| NPI Number | 1023233749 |
|---|---|
| Provider Enumeration Date | 04/16/2007 |
| Last Update Date | 08/27/2014 |
| Medicare PECOS PAC ID | 8224029871 |
|---|---|
| Medicare Enrollment ID | O20040721000250 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023233749 | NPI | - | NPPES |
| 09013996 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 12941 (Mississippi) | Primary |
| Provider Name | Susan F Snyder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073573176 PECOS PAC ID: 0941214860 Enrollment ID: I20060131000356 |
| Provider Name | Krishan K. Gupta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598769176 PECOS PAC ID: 7517958176 Enrollment ID: I20120201000804 |
| Provider Name | Claire Tyler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902152937 PECOS PAC ID: 5799056032 Enrollment ID: I20170804002812 |
| Provider Name | Adriane Wright Harvey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811473481 PECOS PAC ID: 1557790490 Enrollment ID: I20200329000323 |
| Provider Name | Brandy Alexandra Rutland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225628761 PECOS PAC ID: 1052728698 Enrollment ID: I20210329000694 |
| Provider Name | Rachael L Stout |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871366476 PECOS PAC ID: 6002250537 Enrollment ID: I20240222003554 |
| Provider Name | Kaitlynn M Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477390599 PECOS PAC ID: 2668907106 Enrollment ID: I20241121000756 |
Gifted Futures Ms Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 6040 I-55 North Frontage Rd., Jackson, MS 39211 Phone: 929-466-1305 | |
1st Priority Healthcare Services, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 2600 River Ridge Dr, Suite 102, Jackson, MS 39216 Phone: 252-315-5165 Fax: 888-376-1118 | |
Marion Counseling Services, Pllc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 460 Briarwood Dr Ste 510, Jackson, MS 39206 Phone: 601-956-4816 Fax: 601-956-4816 | |