Provider Demographics
NPI:1801639455
Name:RILEY, CRISTY (RN)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2274 SCOTCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:WV
Mailing Address - Zip Code:26440-7130
Mailing Address - Country:US
Mailing Address - Phone:304-692-5865
Mailing Address - Fax:
Practice Address - Street 1:1111 VAN VOORHIS RD STE 2
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2737
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV67219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse