Healthcare Provider Details

I. General information

NPI: 1649095969
Provider Name (Legal Business Name): LILY RIGMAIDEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 BELLE ISLE AVE STE 110J
MOUNT PLEASANT SC
29464-8336
US

IV. Provider business mailing address

PO BOX 201
SIMPSONVILLE SC
29681-0201
US

V. Phone/Fax

Practice location:
  • Phone: 678-673-9692
  • Fax: 470-300-7913
Mailing address:
  • Phone: 303-704-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5515
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: