Provider Demographics
NPI:1083224042
Name:RIELLEY, TERRI LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:RIELLEY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-8905
Mailing Address - Country:US
Mailing Address - Phone:601-754-7115
Mailing Address - Fax:
Practice Address - Street 1:105 CEDAR LN
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-8905
Practice Address - Country:US
Practice Address - Phone:601-754-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS778817163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty