Provider Demographics
NPI:1366163784
Name:RIGGINS, KEITH LANSTOR JR
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:LANSTOR
Last Name:RIGGINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 HERITAGE PARK RD APT 265
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7518
Mailing Address - Country:US
Mailing Address - Phone:717-542-3149
Mailing Address - Fax:
Practice Address - Street 1:12200 HERITAGE PARK RD APT 265
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7518
Practice Address - Country:US
Practice Address - Phone:717-542-3149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist