Provider Demographics
NPI:1023359841
Name:REILEY, BETH M (CRNP)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:REILEY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-2202
Mailing Address - Fax:717-851-4184
Practice Address - Street 1:1101 EDGAR ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2862
Practice Address - Country:US
Practice Address - Phone:717-851-1500
Practice Address - Fax:717-851-1515
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012751363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1619997OtherGATEWAY MEDICARE ASSURED
PAPO1831911OtherRAILROAD MEDICARE
PA2896224OtherHIGHMARK BLUE SHIELD-FREEDOM BLUE
PAPO1831911OtherRAILROAD MEDICARE