Provider Demographics
NPI:1578867164
Name:RILEY, EMILY JOY (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JOY
Last Name:RILEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12348 OLD TESSON RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2251
Mailing Address - Country:US
Mailing Address - Phone:314-467-3800
Mailing Address - Fax:
Practice Address - Street 1:12348 OLD TESSON RD
Practice Address - Street 2:SUITE 160
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2251
Practice Address - Country:US
Practice Address - Phone:314-467-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041912363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics