Healthcare Provider Details

I. General information

NPI: 1326929605
Provider Name (Legal Business Name): CARLA RILEY APRN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W BETHANY DR STE 570
ALLEN TX
75013-3845
US

IV. Provider business mailing address

950 W BETHANY DR STE 570
ALLEN TX
75013-3845
US

V. Phone/Fax

Practice location:
  • Phone: 844-941-3087
  • Fax:
Mailing address:
  • Phone: 844-941-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2025037097
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: