Healthcare Provider Details

I. General information

NPI: 1225580806
Provider Name (Legal Business Name): MARLA JEAN RILEY MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 DAVID L GOLDFEIN ST
HOLLOMAN AIR FORCE BASE NM
88330-8273
US

IV. Provider business mailing address

1655 COUNTRY CLUB CIR
LAS CRUCES NM
88001-1589
US

V. Phone/Fax

Practice location:
  • Phone: 912-596-5241
  • Fax:
Mailing address:
  • Phone: 912-596-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN189160
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: