Provider Demographics
NPI:1740681337
Name:RILEY, KRISTEN NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:NICOLE
Last Name:RILEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5879
Mailing Address - Country:US
Mailing Address - Phone:502-272-5817
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:1000 BRECKENRIDGE ST STE 301
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-0877
Practice Address - Country:US
Practice Address - Phone:502-588-3650
Practice Address - Fax:502-588-7852
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008929363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300019945Medicaid
KY7100372210Medicaid
KY3008929OtherSTATE LICENSE