Healthcare Provider Details

I. General information

NPI: 1962313361
Provider Name (Legal Business Name): AARON RILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 EYEMOUTH DR
BELLA VISTA AR
72715-3503
US

IV. Provider business mailing address

16 EYEMOUTH DR
BELLA VISTA AR
72715-3503
US

V. Phone/Fax

Practice location:
  • Phone: 479-367-1597
  • Fax:
Mailing address:
  • Phone: 479-367-1597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number30762
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: