Provider Demographics
NPI:1467222174
Name:HORDON, RILEY KATHLEEN
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:KATHLEEN
Last Name:HORDON
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 1:12075 E STATE ROUTE 69
Mailing Address - Street 2:
Mailing Address - City:DEWEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86327-4517
Mailing Address - Country:US
Mailing Address - Phone:928-772-1672
Mailing Address - Fax:
Practice Address - Street 1:12075 E STATE ROUTE 69
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:AZ
Practice Address - Zip Code:86327-4517
Practice Address - Country:US
Practice Address - Phone:928-772-1673
Practice Address - Fax:928-772-1674
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ302912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily