Healthcare Provider Details

I. General information

NPI: 1306719570
Provider Name (Legal Business Name): KATY RIEKER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6559 WILSON MILLS RD STE 106A
MAYFIELD VILLAGE OH
44143-3433
US

IV. Provider business mailing address

4952 FAIRLAWN RD
LYNDHURST OH
44124-1123
US

V. Phone/Fax

Practice location:
  • Phone: 855-449-1540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberOO37410
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number0037410
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: