Healthcare Provider Details

I. General information

NPI: 1033678024
Provider Name (Legal Business Name): JAIME LYN RILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME LYN MYERS

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 BEAVER CREEK CIR STE 200
MAUMEE OH
43537-1746
US

IV. Provider business mailing address

7557B DANNAHER DR STE 225
POWELL TN
37849-3568
US

V. Phone/Fax

Practice location:
  • Phone: 419-891-6201
  • Fax: 419-893-1227
Mailing address:
  • Phone: 865-647-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34.018266
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO5092
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: