Provider Demographics
NPI:1831821420
Name:MCKUIN, RILEY NICOLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:NICOLE
Last Name:MCKUIN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:NICOLE
Other - Last Name:GREENWALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:210 RUTH HARRIS LN
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2206
Mailing Address - Country:US
Mailing Address - Phone:573-300-8117
Mailing Address - Fax:
Practice Address - Street 1:3100 OAK GROVE RD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-1573
Practice Address - Country:US
Practice Address - Phone:573-776-2000
Practice Address - Fax:573-686-8210
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022010858363LP0808X
MO2022028517363LP0808X
MO2018021822163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health