Provider Demographics
NPI:1336034420
Name:DELAVAN, RILEY KATHERINE
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:KATHERINE
Last Name:DELAVAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 ROCKDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-7161
Mailing Address - Country:US
Mailing Address - Phone:803-983-4992
Mailing Address - Fax:
Practice Address - Street 1:1070 ROCKDALE BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-7161
Practice Address - Country:US
Practice Address - Phone:803-983-4992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant