Provider Demographics
NPI:1932629649
Name:RILEY, ALYSSA FAITH (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:FAITH
Last Name:RILEY
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:FAITH
Other - Last Name:DILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MMS, PA-C
Mailing Address - Street 1:3200 ROCKBRIDGE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1431 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4211
Practice Address - Country:US
Practice Address - Phone:704-709-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00435800363A00000X
NC0010-11185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant