Provider Demographics
NPI:1427395698
Name:ARAGON RILEY, JACQUELINE (FNP)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ARAGON RILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 W MCDERMOTT DR STE 150
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3424
Mailing Address - Country:US
Mailing Address - Phone:469-340-2777
Mailing Address - Fax:
Practice Address - Street 1:1774 W MCDERMOTT DR STE 150
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3424
Practice Address - Country:US
Practice Address - Phone:469-340-2777
Practice Address - Fax:469-208-0230
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60226853163W00000X
TXAP144142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
0294713OtherLABOR & INDUSTRIES