Provider Demographics
NPI:1801528765
Name:RILEY, MELISSA GRACE (CRNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GRACE
Last Name:RILEY
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14703 MADDOX RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-6532
Mailing Address - Country:US
Mailing Address - Phone:334-488-4808
Mailing Address - Fax:
Practice Address - Street 1:135 MEDICAL PARK DR STE 2B
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5352
Practice Address - Country:US
Practice Address - Phone:855-527-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-145931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily