Provider Demographics
NPI:1851519805
Name:RILEY, RHONDA (APRN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4793 VILLAGE SQUARE DR STE A-1
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-7435
Mailing Address - Country:US
Mailing Address - Phone:270-444-3947
Mailing Address - Fax:
Practice Address - Street 1:4793 VILLAGE SQUARE DR STE A-1
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7435
Practice Address - Country:US
Practice Address - Phone:270-444-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily