Healthcare Provider Details

I. General information

NPI: 1548897051
Provider Name (Legal Business Name): EMILY LYNN RILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL MSC 8116-0043-08
ST LOUIS MO
63110
US

IV. Provider business mailing address

1 CHILDRENS PL MSC 8116-0043-08
ST LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6095
  • Fax: 314-454-2561
Mailing address:
  • Phone: 314-454-6095
  • Fax: 314-454-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2024023132
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: