Provider Demographics
NPI:1073981841
Name:RIGGIERI, KELLY ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:RIGGIERI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:DESIMONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:46 YALE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8504
Mailing Address - Country:US
Mailing Address - Phone:401-316-3605
Mailing Address - Fax:
Practice Address - Street 1:345 N MAIN ST
Practice Address - Street 2:SUITE 245
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2515
Practice Address - Country:US
Practice Address - Phone:860-236-3000
Practice Address - Fax:860-236-3002
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6274363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily