Most Relevant Information
Provider Data
| NPI Number: | 1003351115 |
| Provider Name: | JERRY PRIDDY PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 085006117 |
Most Important Dates
| Enumeration Date: | 12/28/2016 |
| Last Updated: | 04/13/2020 |
Provider Practice Location
1301 S KOKE MILL RD
SPRINGFIELD
IL
62711
Practice Location Phone/Fax
| Phone: | 2175479100 |
| Fax: | 2175479236 |
Provider Mailing Location
1301 S KOKE MILL RD
SPRINGFIELD
IL
627119252
Provider Mailing Phone/Fax
| Phone: | 2175479100 |
| Fax: | 2175479236 |