Provider Demographics
NPI:1447841606
Name:RIGGINS, KIMBERLY ALAINE (CNM)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALAINE
Last Name:RIGGINS
Suffix:
Gender:
Credentials:CNM
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ALAINE
Other - Last Name:AXSOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9070 E PERSIMMON RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:47424-5775
Mailing Address - Country:US
Mailing Address - Phone:812-327-5832
Mailing Address - Fax:
Practice Address - Street 1:9070 E PERSIMMON RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IN
Practice Address - Zip Code:47424-5775
Practice Address - Country:US
Practice Address - Phone:812-327-5832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-31
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28209852A163WX0003X
367A00000X
IN09000367A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300054217Medicaid
IN000001562816OtherANTHEM PTAN