Healthcare Provider Details

I. General information

NPI: 1902770563
Provider Name (Legal Business Name): LISA RIGGLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 S SILVER SPRINGS RD
CAPE GIRARDEAU MO
63703-7539
US

IV. Provider business mailing address

4001 S 700 E STE 300
SALT LAKE CITY UT
84107-2514
US

V. Phone/Fax

Practice location:
  • Phone: 832-869-4818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025044121
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: