Provider Demographics
NPI:1518557099
Name:SEPTIMIO, KELSEY RIGGS (PA)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:RIGGS
Last Name:SEPTIMIO
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1365 BROADCLOTH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-4507
Mailing Address - Country:US
Mailing Address - Phone:919-649-8699
Mailing Address - Fax:
Practice Address - Street 1:1365 BROADCLOTH ST STE 203
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-4507
Practice Address - Country:US
Practice Address - Phone:803-402-4410
Practice Address - Fax:803-526-7662
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC305193207Q00000X
SC4122207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine