Healthcare Provider Details

I. General information

NPI: 1598738965
Provider Name (Legal Business Name): KATHLEEN MARIE RILEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FORT CARSON CO
80913-4603
US

IV. Provider business mailing address

5807 MESA MOUNTAIN WAY
COLORADO SPRINGS CO
80922-3451
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-1218
  • Fax: 719-526-7673
Mailing address:
  • Phone: 719-591-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number93853
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: