Healthcare Provider Details

I. General information

NPI: 1982523783
Provider Name (Legal Business Name): TRISTAN JAMES RILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 LINCOLN AVE
EVANSVILLE IN
47722-1000
US

IV. Provider business mailing address

612 VILLAGE LN APT J
NEWBURGH IN
47630-1625
US

V. Phone/Fax

Practice location:
  • Phone: 812-664-1069
  • Fax: 812-909-7200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: