MEDICARE: PAMELA RILEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	20168	TN
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	20168	TN

General Provider Information

NPI Number	:	1164807186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA RILEY NP

Provider Business Mailing Address
First Line	:	11100 OLD HWY 64
Second Line	:
City	:	BOLIVAR
State	:	TN
Zip	:	38008
Country	:	US
Telephone Number	:	731-228-0657
Fax Number	:

Provider Business Practice Location Address
First Line	:	854 MULBERRY AVE
Second Line	:
City	:	SELMER
State	:	TN
Zip	:	38375-2334
Country	:	US
Telephone Number	:	731-646-1781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	11/12/2025

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Directions to “ PAMELA RILEY NP” Practice Location

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