Provider Demographics
NPI:1316182934
Name:RILEY, NATHAN ALLEN (NP)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:ALLEN
Last Name:RILEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-424-4602
Mailing Address - Fax:812-421-5147
Practice Address - Street 1:1750 OAK HILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4364
Practice Address - Country:US
Practice Address - Phone:812-424-4602
Practice Address - Fax:812-421-5147
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71004194A363L00000X
IN28150891A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner