Provider Demographics
NPI:1104385111
Name:RIGGS, STACY JEAN (CPNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JEAN
Last Name:RIGGS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 CREEKWOOD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-1201
Mailing Address - Country:US
Mailing Address - Phone:865-986-1400
Mailing Address - Fax:865-986-9400
Practice Address - Street 1:136 MOUNTAIN PERKINS LN STE 2
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2841
Practice Address - Country:US
Practice Address - Phone:423-562-4149
Practice Address - Fax:423-566-6929
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25579363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics