Healthcare Provider Details

I. General information

NPI: 1063681641
Provider Name (Legal Business Name): JUDY ANN LILLY-RIGGSBEE CFM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 PAGE RD
PINEHURST NC
28374-8751
US

IV. Provider business mailing address

PO BOX 4754
PINEHURST NC
28374-4754
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-2828
  • Fax: 910-295-2996
Mailing address:
  • Phone: 910-295-2828
  • Fax: 910-295-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: