Healthcare Provider Details

I. General information

NPI: 1235578964
Provider Name (Legal Business Name): JANELLE K RILEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2013
Last Update Date: 01/10/2024
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 N 7TH ST
LEAVENWORTH KS
66048-1422
US

IV. Provider business mailing address

818 N 7TH ST
LEAVENWORTH KS
66048-1422
US

V. Phone/Fax

Practice location:
  • Phone: 913-651-8860
  • Fax: 913-682-4409
Mailing address:
  • Phone: 913-651-8860
  • Fax: 913-682-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101258533
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: