Provider Demographics
NPI:1669995940
Name:RILEY, KATHRYN (PNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 48TH ST APT 9D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1513
Mailing Address - Country:US
Mailing Address - Phone:845-926-7843
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-6443
Practice Address - Fax:718-741-2150
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY689356163WP0218X
NY382925363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care
No163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology