Healthcare Provider Details

I. General information

NPI: 1336596600
Provider Name (Legal Business Name): ANTHONY RALEY APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 N MILDRED RD
CORTEZ CO
81321-2231
US

IV. Provider business mailing address

PO BOX 18667
ERLANGER KY
41018-0667
US

V. Phone/Fax

Practice location:
  • Phone: 970-565-6666
  • Fax:
Mailing address:
  • Phone: 859-572-3617
  • Fax: 859-572-2326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10367
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0997279-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3010296
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: