Provider Demographics
NPI:1639389802
Name:RILEY, JACQUELINE BETH (NP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:BETH
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 1:31 SMOKEY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6161
Mailing Address - Country:US
Mailing Address - Phone:518-561-5911
Mailing Address - Fax:
Practice Address - Street 1:159 MARGARET ST
Practice Address - Street 2:SUITE 600
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1874
Practice Address - Country:US
Practice Address - Phone:518-563-2057
Practice Address - Fax:518-563-2094
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304711363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health