MEDICARE: MRS. KAREN INDRA RIGGS CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	ARNP9417615	FL
2	363LP0200X	Pediatric Nurse Practitioner	617680	TX

General Provider Information

NPI Number	:	1952635427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN INDRA RIGGS CPNP

Provider Business Mailing Address
First Line	:	353 INDIAN WOMAN ROAD
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459
Country	:	US
Telephone Number	:	817-578-1622
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4411
Country	:	US
Telephone Number	:	850-257-5524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2009
Last Update Date	:	05/03/2017

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