Provider Demographics
NPI:1770277030
Name:RILEY, ASHLEY JADE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JADE
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 1:92 NE 421 LOOP
Mailing Address - Street 2:
Mailing Address - City:SPAVINAW
Mailing Address - State:OK
Mailing Address - Zip Code:74366-2170
Mailing Address - Country:US
Mailing Address - Phone:918-373-6472
Mailing Address - Fax:
Practice Address - Street 1:3001 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2544
Practice Address - Country:US
Practice Address - Phone:918-965-3620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist