Healthcare Provider Details

I. General information

NPI: 1205765187
Provider Name (Legal Business Name): KELLY REBECCA ANDERSEN-RIGGS L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N HEMMER RD STE 213
PALMER AK
99645-9673
US

IV. Provider business mailing address

PO BOX 410
SUTTON AK
99674-0410
US

V. Phone/Fax

Practice location:
  • Phone: 907-746-0005
  • Fax:
Mailing address:
  • Phone: 907-715-2212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number130317
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: