Healthcare Provider Details

I. General information

NPI: 1053295881
Provider Name (Legal Business Name): KRISTA NICOLE RILEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 THE BOULEVARD SAINT LOUIS
SAINT LOUIS MO
63117-1118
US

IV. Provider business mailing address

35 THE BOULEVARD SAINT LOUIS
SAINT LOUIS MO
63117-1118
US

V. Phone/Fax

Practice location:
  • Phone: 314-256-1290
  • Fax:
Mailing address:
  • Phone: 314-256-1290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2007034620
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number2007034620
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: