Provider Demographics
NPI:1841038239
Name:RILEY, JENNA M (PA-C)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:RILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4525 S 86TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9277
Mailing Address - Country:US
Mailing Address - Phone:402-483-7505
Mailing Address - Fax:402-483-6899
Practice Address - Street 1:4525 S 86TH ST STE B
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9277
Practice Address - Country:US
Practice Address - Phone:402-483-7505
Practice Address - Fax:402-483-6899
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE3128363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant