Provider Demographics
NPI:1528026275
Name:RILEY, KIM E (NP)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:E
Last Name:RILEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:SUITE A-100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:2055 W HOSPITAL DR
Practice Address - Street 2:#255
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7892
Practice Address - Country:US
Practice Address - Phone:520-547-5725
Practice Address - Fax:520-547-5735
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN049354363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S51257Medicare UPIN