Provider Demographics
NPI:1770373144
Name:RILEY, LARKIN LEE (NBC-HWC)
Entity type:Individual
Prefix:
First Name:LARKIN
Middle Name:LEE
Last Name:RILEY
Suffix:
Gender:
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 E KINGMAN ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-6730
Mailing Address - Country:US
Mailing Address - Phone:520-450-0076
Mailing Address - Fax:
Practice Address - Street 1:1170 E KINGMAN ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6730
Practice Address - Country:US
Practice Address - Phone:520-450-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-4045170171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach