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General NPI Number Information
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NPI Number | 1336667732
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Entity Type | Individual
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Provider Name | KRISTIN RILEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/06/2017
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1375 N MAIN ST
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City | LAPEER
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State | MI
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Zip | 48446-1350
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Country | US
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Telephone | 810-667-5204
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Fax |
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Provider Business Mailing Address
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Address Line | 2147 PROFESSIONAL DR
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City | GAYLORD
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State | MI
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Zip | 49735-0003
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Country | US
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Telephone | 989-732-1753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601008368
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5601008368
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License Number State | MI
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