Healthcare Provider Details

I. General information

NPI: 1972119634
Provider Name (Legal Business Name): TIFFANY ANN RIGDON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 ALBRIGHT RD
KOKOMO IN
46902-3996
US

IV. Provider business mailing address

190 S LIBERTY ST
RUSSIAVILLE IN
46979-9125
US

V. Phone/Fax

Practice location:
  • Phone: 765-438-8515
  • Fax:
Mailing address:
  • Phone: 765-753-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-37253
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: