Provider Demographics
NPI:1154830438
Name:RIGGINS, JERRI
Entity Type:Individual
Prefix:MRS
First Name:JERRI
Middle Name:
Last Name:RIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:CITRONELLE
Mailing Address - State:AL
Mailing Address - Zip Code:36522
Mailing Address - Country:US
Mailing Address - Phone:251-421-9067
Mailing Address - Fax:
Practice Address - Street 1:8240 WOODLAND DR S
Practice Address - Street 2:
Practice Address - City:CITRONELLE
Practice Address - State:AL
Practice Address - Zip Code:36522-2796
Practice Address - Country:US
Practice Address - Phone:251-421-9067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3819874172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty