Provider Demographics
NPI:1659454403
Name:RIGGINS, JOVONNA R (PA)
Entity Type:Individual
Prefix:MRS
First Name:JOVONNA
Middle Name:R
Last Name:RIGGINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:R
Other - Last Name:RIGGINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307
Mailing Address - Country:US
Mailing Address - Phone:423-338-8995
Mailing Address - Fax:423-338-8996
Practice Address - Street 1:6784 HIGHWAY 411
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:TN
Practice Address - Zip Code:37307-4818
Practice Address - Country:US
Practice Address - Phone:423-338-2831
Practice Address - Fax:423-338-2833
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3668519Medicaid
TN3073274OtherBLUE CARE
TNTN0101OtherJOHN DEERE
TN3668512Medicare PIN
TNTN0101OtherJOHN DEERE