Provider Demographics
NPI:1053081406
Name:RILEY, OLIVIA (NP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE STE 821B
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5223
Mailing Address - Country:US
Mailing Address - Phone:901-979-5501
Mailing Address - Fax:
Practice Address - Street 1:6005 PARK AVE STE 821B
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5223
Practice Address - Country:US
Practice Address - Phone:901-979-5501
Practice Address - Fax:901-433-9701
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30284363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health