Provider Demographics
NPI:1194015834
Name:RILEY, PEGGY (RN FNP-C)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:RN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5409
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5409
Mailing Address - Country:US
Mailing Address - Phone:325-437-8620
Mailing Address - Fax:325-437-8695
Practice Address - Street 1:3449 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603
Practice Address - Country:US
Practice Address - Phone:325-437-8620
Practice Address - Fax:325-437-8695
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily