Individual provider Active NPI

Derrick Shayne Riggin

  • Peer Specialist
  • Tulsa, OK
National Provider Identifier
1740142199
Registry record updated Nov 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
License
L977963424 Issued in OK
Practice address
6365 S 84TH East Ave
Tulsa, OK 74133-1318
Phone
(918) 539-2610
NPI assigned
Nov 24, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X L977963424 OK Primary

Addresses

Primary practice location

6365 S 84TH East Ave
Tulsa, OK 74133-1318

Mailing address

6365 S 84TH East Ave
Tulsa, OK 74133-1318
Phone (918) 539-2610

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
L977963424OKMDPeer Specialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1763942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763942400000",
    "number": "1740142199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6365 S 84TH EAST AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741331318",
            "telephone_number": "918-539-2610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6365 S 84TH EAST AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741331318",
            "telephone_number": "918-539-2610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIGGIN",
        "first_name": "DERRICK",
        "middle_name": "SHAYNE",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-11-24",
        "last_updated": "2025-11-24",
        "certification_date": "2025-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "OK",
            "license": "L977963424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.