Provider Demographics
NPI:1962004648
Name:RILEY, BRITTANY DAWN
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DAWN
Last Name:RILEY
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 1:922 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25514-8639
Mailing Address - Country:US
Mailing Address - Phone:304-648-2124
Mailing Address - Fax:
Practice Address - Street 1:922 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:FORT GAY
Practice Address - State:WV
Practice Address - Zip Code:25514-8639
Practice Address - Country:US
Practice Address - Phone:304-648-2124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant