Provider Demographics
NPI:1649273525
Name:RILEY, ANGELA K (ARNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:K
Last Name:RILEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-525-0005
Mailing Address - Fax:859-525-8806
Practice Address - Street 1:900 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-331-0774
Practice Address - Fax:859-578-3800
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002496363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0087978Medicaid
500008873OtherPALMETTO GBA-RAILROAD MEDICARE
KY78024965Medicaid
KY78024965Medicaid
KYP400040823Medicare PIN
500008873OtherPALMETTO GBA-RAILROAD MEDICARE