Provider Demographics
NPI:1245799113
Name:RIGGINS, JOHNETHA PRIDGEN (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:MRS
First Name:JOHNETHA
Middle Name:PRIDGEN
Last Name:RIGGINS
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 GUESS RD STE F
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2678
Mailing Address - Country:US
Mailing Address - Phone:919-757-8467
Mailing Address - Fax:
Practice Address - Street 1:3101 GUESS RD STE F
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2678
Practice Address - Country:US
Practice Address - Phone:919-757-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty