Healthcare Provider Details

I. General information

NPI: 1548863921
Provider Name (Legal Business Name): STACEY RILEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 ILAHEE LN
CHICO CA
95973-7205
US

IV. Provider business mailing address

19 ILAHEE LN
CHICO CA
95973-7205
US

V. Phone/Fax

Practice location:
  • Phone: 530-487-7111
  • Fax: 530-487-7122
Mailing address:
  • Phone: 530-487-7111
  • Fax: 530-487-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016356
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number778135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: