Healthcare Provider Details

I. General information

NPI: 1902262033
Provider Name (Legal Business Name): CHERI RILEY PLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E CANAAN RD
GERALD MO
63037-2514
US

IV. Provider business mailing address

512 E CANAAN RD
GERALD MO
63037-2514
US

V. Phone/Fax

Practice location:
  • Phone: 573-764-4748
  • Fax:
Mailing address:
  • Phone: 573-764-4748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2015042359
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: