Healthcare Provider Details

I. General information

NPI: 1861704256
Provider Name (Legal Business Name): JESSICA J. RIGGINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA J. FRAYER RN

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BARNHILL DR ROC 4340
INDIANAPOLIS IN
46202-5128
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-5611
  • Fax: 317-944-3107
Mailing address:
  • Phone: 317-274-1201
  • Fax: 317-278-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number28145285A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71002418A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: