Healthcare Provider Details

I. General information

NPI: 1881224111
Provider Name (Legal Business Name): JAMISON K RIGLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date: 02/09/2023
Reactivation Date: 12/10/2025

III. Provider practice location address

4406 114TH ST
URBANDALE IA
50322-5409
US

IV. Provider business mailing address

4406 114TH ST
URBANDALE IA
50322-5409
US

V. Phone/Fax

Practice location:
  • Phone: 515-509-6892
  • Fax:
Mailing address:
  • Phone: 515-509-6892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: