Provider Demographics
NPI:1437436706
Name:RILEY, AMBER NICOLE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NICOLE
Last Name:RILEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:NICOLE
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:8902 N MERIDIAN ST
Mailing Address - Street 2:STE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5382
Mailing Address - Country:US
Mailing Address - Phone:317-848-8048
Mailing Address - Fax:317-575-8807
Practice Address - Street 1:8902 N MERIDIAN ST
Practice Address - Street 2:STE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5382
Practice Address - Country:US
Practice Address - Phone:317-848-8048
Practice Address - Fax:317-575-8807
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ 28185935A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71003838AOtherAPN PRESCRIPTIVE AUTHORITY
INA0811105OtherNP-C LICENSE