Healthcare Provider Details

I. General information

NPI: 1396365995
Provider Name (Legal Business Name): MRS. KELSEY BRIANA RIGGIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EAGLE CREST ST
RANGELY CO
81648-3105
US

IV. Provider business mailing address

225 EAGLE CREST DR
RANGELY CO
81648-3105
US

V. Phone/Fax

Practice location:
  • Phone: 970-675-5011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0006579
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: